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At least 271 records · Page 15Linked to original sources
PubMed2002

Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips.

The results of cemented total hip arthroplasty (THA) in patients with ankylosing spondylitis were studied to determine the utility of THA for these patients. A total of 103 patients with ankylosing spondylitis underwent 181 THAs; 72 patients (69.9%) had bilateral surgery. The mean follow-up was 10.3 years. The mean age of patients at surgery was 47 years. Before surgery, 42 hips (23.2%) were ankylosed. Revision surgery was carried out in 25 hips (13.8%). Heterotopic ossification was present in 21 hips (11.6%); however, no patients had functional impairment or reankylosis. At final follow-up examination, 173 hips (96%) had an excellent (low) pain score, and 53 hips had a normal or near-normal function score (29.2%). The probability of survival of the implant was 71% at 27 years. THA provides long-term improvement in hip function for patients with ankylosing spondylitis.

Arthroplasty, Replacement, Hip↗
PubMed2001

Hip abductor strength following total hip arthroplasty: a prospective comparison of the posterior and lateral approach in 100 patients.

We studied the hip abductor strength and Trendelenburg test prospectively in 100 patients undergoing total hip replacement via a lateral or posterior approach. In 49 patients, we used the lateral approach to implant the Charnley total hip replacement, and in 51 patients, the posterior approach to implant the Exeter total hip. Isometric abductor strength was measured with the kinetic communicator device and the Trendelenburg test was recorded preoperatively and at 3 and 12 months postoperatively. Of the original 100 patients, 83 were available for study at 3 months and 73 at 12 months. Hip abductor strength and the Trendelenburg test improved postoperatively in both groups, but we found no difference in hip abductor strength recovery at 3 and 12 months between the lateral approach and the posterior approach. Similarly there was no difference in the Trendelenburg test between the two groups 3 and 12 months following hip replacement.

Adult↗
PubMed1996

Total hip replacement in dysplastic hips using femoral head shelf autografts.

A consecutive series of 30 dysplastic hips were treated with total hip arthroplasty using femoral head autograft shelf reconstruction and were reviewed. Cemented cups were used in 13 hips and uncemented cups were used in 17 hips. The average followup was 8.1 years (range, 5.2-13.3 years). In the cemented group, the average preoperative Harris Hip Score was 44.8 points (range, 22-82 points), and in the uncemented group, it was 45 points (range, 23-61 points). At the final review, the average clinical score was 71.5 points (range, 46-98 points) in the cemented group, and in the uncemented group it was 87.5 points (range, 63-100 points). Of the 30 cases, only 3 had unsuccessful results, giving a success rate of 90%. In terms of the autograft, all united to host bone. Resorption, when seen in either cemented or uncemented cups, was minor and restricted to the lateral nonweightbearing part of the graft. The present study supports using shelf autografts to reconstruct dysplastic hips at the time of total hip arthroplasty. In this series, cemented and uncemented cups performed equally well.

Adult↗
PubMedDate not supplied

Total hip arthroplasty after childhood septic hip in patients younger than 25 years of age.

Childhood septic hip should usually be treated immediately by arthrotomy and antibiotic. Even if treated correctly, the affected hip may become osteoarthritic and functionally disabling. Usually the literature is not in favor of total hip arthroplasty in young patients, and the reports are on patients older than 32 years of age. We present here a unique group of very young patients with early coxarthrosis caused by septic hip in childhood, with an average age of 19.14 years (range, 14-25) at the time of the arthroplasty. The Harris hip score improved from a preoperative mean of 58.43 to a postoperative mean of 94.14. The follow-up period ranged between 2 and 24 years, with an average of 8.14 years. We conclude that total hip arthroplasty in young people with early coxarthrosis caused by septic hip in childhood provides good functional results.

Adolescent↗
PubMed2004

Mechanoreceptor evaluation of hip joint capsule and ligamentum capitis femoris in developmental hip dysplasia: a preliminary study.

We aimed to determine if there are mechanoreceptors in the hip joint capsule and ligamentum capitis femoris (LCF) of patients with developmental dysplasia of the hip (DDH). We took capsule and LCF biopsies from 20 hips of 20 patients who were operated on because of DDH. The mean age was 10.2 months (range 6-20 months) at the time of surgery. There were 12 girls and eight boys. Teratologic and secondary hip dislocations were not included in this study. Full thickness, 0.5 x 0.5 cm anterior capsule and LCF portions were taken for biopsy specimen. Specimens were stained with hemotoxylin eosin and examined immunohistochemically using monoclonal antibody against S-100 protein. In both analyses no mechanoreceptor was found in any samples of capsule or LCF. In this preliminary study we could not find mechanoreceptors in the local anterior joint capsule and LCF of the hip in children with DDH. We think that additional studies are necessary in order to understand the mechanoreceptor characteristics of the hip joint in children not only with DDH but also in children with healthy hips.

Biopsy, Needle↗
PubMed2000

Sonography for hip joint effusion in adults with hip pain.

OBJECTIVE: To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. METHODS: Patients (n = 224) aged 50 years or older with hip pain, referred by the general practitioner for radiological investigation, underwent a standardised examination. The distance between the ventral capsule and the femoral neck, an increase in which represents joint effusion, was measured sonographically. Joint effusion was defined in three different ways: "effusion" according to Koski's definition, "major effusion", and "asymmetrical effusion" based on only individual side differences. RESULTS: "Effusion" was present in 80 (38%), "major effusion" in 20 (9%), and "asymmetrical effusion" in 47 (22%) patients. Pain in the groin or medial thigh, pain aggravated by lying on the side, decreased extension/internal rotation/abduction/flexion, painful external rotation, and pain on palpation in the groin showed a significant relation (adjusted for age and radiological osteoarthritis of the hip) with ultrasonic hip joint effusion. "Major effusion" showed a significant relation with an increased ESR. When patients with bilateral pain and increased ESR were excluded, a side difference in the range of motion of extension of the hip was shown to be a good predictor for "asymmetrical effusion" (positive predictive value: 71%, negative predictive value: 80%). CONCLUSION: This study showed a relatively high prevalence of ultrasonic joint effusion in adults with hip pain in general practice. Furthermore the results indicate a relation between joint effusion and clinical signs.

Aged↗
PubMedDate not supplied

Relation between increase in length of hip axis in older women between 1950s and 1990s and increase in age specific rates of hip fracture.

OBJECTIVE: To determine whether length of hip axis in elderly women has increased over the past 40 years and, if so, whether the increase may have contributed to the increase in the age adjusted rate of hip fractures during those years. DESIGN: Retrospective assessment of anteroposterior x ray films of the pelvis. SETTING: Radiology department of a rheumatology hospital, New Zealand. PATIENTS: Two cohorts of women aged > 60 (mean 70) who were x rayed on the same apparatus in either the 1950s or the 1990s. MAIN OUTCOME: Length of hip axis (distance from the medial aspect of the pelvis to the lateral aspect of the femur along the axis of the femoral neck), length of femoral neck (length of hip axis excluding the femoral head and more medial structures), and width of femoral neck (see figure). RESULTS: Both the mean length of the hip axis and the mean length of the femoral neck were significantly greater in the women whose x ray films were taken in the 1990s than in those in the 1950s (124.0 mm (SE 1) v 130.5 (1), P = 0.0002; 79.4 (1) v 84.9 (1), P < 0.0001, respectively). The width of the femoral neck did not change, and the lengths expressed as ratios to width were greater in the more recent x ray films, indicating that these findings are not due to an unrecognised change in radiographic technique. CONCLUSIONS: An increase in the length of the hip axis in elderly women in New Zealand during the past 40 years has occurred which is large enough to account for the increase in the age adjusted rate of hip fractures during those years.

Aged↗
PubMed1988

Heterotopic bone formation after hip surgery: prevention with single-dose postoperative hip irradiation.

From 1981 to 1986, 23 patients (24 hips) were treated with single-dose irradiation after hip surgery in an attempt to prevent heterotopic bone formation. All patients were at high risk for the development of heterotopic ossification because of the presence of heterotopic bone in either hip secondary to trauma or previous surgery, ankylosing spondylitis, or hypertrophic osteoarthritis. Thirteen patients (14 hips) underwent primary total-hip arthroplasty, and ten patients underwent revision total-hip arthroplasty or excision of heterotopic bone. The minimum follow-up period was 6 months. All patients were treated by means of a linear accelerator with a single dose of 700 cGy, calculated at midplane. Almost all treatments were given within 72 hours after surgery. Recurrent disease of Brooker grade II type developed in only one (4%) patient. This result is comparable with outcomes reported after fractionated courses of postoperative radiation therapy delivered over a period of 1 or 2 weeks. Postoperative hip irradiation with a single 700-cGy dose appears to be as effective as fractionated courses of radiation in the prevention of heterotopic bone formation in patients at high risk for the development of this complication.

Adult↗
PubMed2002

A radiographic study of hip-joint alignment after prosthetic hip arthoplasty.

Postoperative hip alignment was studied on radiographs in cases of total hip arthroplasty (THA) and of Bipolar Head Prosthesis(BHP), both with MX-1. Postoperative anteroposterior-view radiographs of hip joints of patients with a normal hip joint on the unoperated side and without pelvic tilt were used. Thirty-nine THA patients (femoral neck fracture), 26 THA patients (osteonecrosis of the femoral head and osteoarthritis of the hip joint), and 34 BHP patients were selected for this study. Lines and points for measurement of 9 parameters were established on radiographs. The position of the greater trochanter upper edge is 6.5 mm (mean) superior to the femoral head center in the normal hip joint of Japanese, unlike in Caucasians. A femoral head prosthesis should be inserted so that its center and the greater trochanter upper edge are level in order to equalize leg lengths. In BHP cases, the insertion is made so that the greater trochanter upper edge is approximately 4-mm superior to the center of the prosthesis. For further securing of the stem and to equalize leg lengths, stems should be available in 11 diameters from 5-15 mm in 1-mm increments. Postoperative hip alignment in MX-1 THA cases was found to be satisfactory.

Aged↗
PubMed2003

Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures.

BACKGROUND: Failed treatment of an intertrochanteric fracture typically leads to profound functional disability and pain. Treatment with repeated attempts to gain union and to preserve the host femoral head usually is preferred for young patients, but salvage treatment with hip arthroplasty may be considered for selected older patients with poor bone quality, bone loss, or articular cartilage damage. The purpose of the present study was to evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of an intertrochanteric hip fracture. METHODS: Between 1985 and 1997, sixty patients (forty-nine women and eleven men) with a mean age of seventy-eight years were treated at our institution with hip arthroplasty after the failed treatment of an intertrochanteric fracture. Thirty-two patients had a total hip arthroplasty with a cemented cup (twenty-four patients) or an uncemented cup (eight patients), twenty-seven had a bipolar hemiarthroplasty, and one had a unipolar hemiarthroplasty. A calcar-replacement design, extended-neck stem, or long-stem implant was used in fifty-one of the sixty hips. RESULTS: Ten patients died within two years (all with the implant intact), and six were lost to follow-up. The remaining forty-four patients were followed for a mean of five years (range, two to fifteen years). At the time of the last follow-up, thirty-nine patients had no or mild pain and five had moderate or severe pain; in all of these patients, the pain was in the region of the greater trochanter. Forty patients were able to walk, twenty-six with one-arm support or less. Twelve patients had a total of thirteen medical complications postoperatively. A total of five reoperations were performed: two patients had a revision, one had a rewiring procedure because of trochanteric avulsion, one had late removal of trochanteric hardware, and one had débridement of fat necrosis. One patient had two dislocations, both of which were treated with closed reduction. Kaplan-Meier survivorship analysis with revision of the implant for any reason as the end point revealed a survival rate of 100% at seven years and 87.5% (95% confidence interval, 67.3% to 100%) at ten years. CONCLUSIONS: Hip arthroplasty is an effective salvage procedure after the failed treatment of an intertrochanteric fracture in an older patient. Most patients have good pain relief and functional improvement. Calcar-replacement and long-stem implants often are required. Despite the operative challenges, surprisingly few serious orthopaedic complications were associated with this procedure in the present study.

Aged↗
PubMed2005

Total hip arthroplasty with cement and without acetabular bone graft for severe hip dysplasia. A concise follow-up, at a minimum of twenty years, of a previous report.

We previously evaluated a cohort of fifty-three patients with severe hip dysplasia (Crowe Type-II, III, or IV subluxation) who underwent a total of sixty-six Charnley total hip arthroplasties. The acetabular component was placed at the anatomic hip center, the superolateral defect was filled with cement, and no bone-grafting was used to supplement the acetabular wall. All but one patient, who was lost to follow-up, were followed until death or for a minimum of twenty years. Radiographic and functional follow-up data were collected prospectively. This retrospective review included twenty-four patients (thirty-four hips) who were alive at a minimum of twenty years following the surgery. Fourteen (22%) of the sixty-five hips underwent revision of a component, with eleven of the revisions performed because of aseptic loosening. Eight of those eleven hips underwent revision because of acetabular loosening alone; two, because of femoral loosening alone; and one, because of loosening of both components. The combined prevalence of revision because of aseptic loosening of the acetabular component and radiographic evidence of failure of the acetabular component was 28% (eighteen hips). With the numbers available, the need for acetabular revision was not associated with the percentage of cement coverage (p = 0.362) or the Crowe classification (p = 0.159). At a minimum of twenty years postoperatively, the survivorship of the acetabular component was 86% +/- 8% with revision because of aseptic loosening as the end point and 82% +/- 10% with revision because of aseptic loosening or radiographic evidence of loosening as the end point. The results that we evaluated at a minimum of twenty years after use of this technique can be compared with the results of other techniques in studies with similar long-term follow-up periods.

Adult↗
PubMed1993

Isometric hip abductor strength following total hip replacement and its relationship to functional assessments.

Despite the rehabilitative emphasis on hip abductor strength following total hip replacement (THR), it is unclear how muscular strength is related to function. The purposes of this study were to examine changes in hip abductor strength during the first 6 months following THR and to determine the relationship between hip abductor strength and functional performances. Forty-three patients (mean age 64 +/- 7 years) completed strength assessments before surgery and at 1, 6, 12, and 24 weeks after surgery, and functional assessments before surgery and at 12 and 24 weeks after surgery. Both hip abductor strength and functional performance were significantly improved at each assessment (p < 0.01). The correlation between isometric hip abductor torques and the distance walked in 6 minutes was modestly high (r = 0.48-0.51; p < 0.01). This study provides baseline data for isometric hip abductor strength that can be used comparatively to assess patient progress and to help set clinical goals. Although strength is related to function, isometric measurements of strength should not be relied upon as the sole predictors of function in patients who have undergone THR.

Bone Cements↗
PubMed1997

Case study: physical therapy management of hip osteoarthritis prior to total hip arthroplasty.

It is important that we have information on the role of physical therapists in the treatment of patients with osteoarthritis of the hip prior to total hip arthroplasty. This article describes the management of a patient with limited range of motion of the right hip due to osteoarthritis. The patient made a significant improvement with decreased pain, increased range of motion of the right hip, increased periarticular muscle strength, improved gait, and improved mobility. One year later, the patient had a right total hip arthroplasty. The rationale of the management of patients with osteoarthritis of the hip is discussed. In addition, the role of physical therapists in the management and treatment of patients with osteoarthritis prior to total hip arthroplasty is discussed.

Female↗
PubMed1999

An electromyographic study of the hip abductor muscles as subjects with a hip prosthesis walked with different methods of using a cane and carrying a load.

BACKGROUND AND PURPOSE: Certain methods of carrying handheld loads or using a cane can reduce the demands placed on the hip abductor (HA) muscles and the loads on the underlying prosthetic hip. In certain conditions, unusually large forces from the HA muscles may contribute to premature loosening of a prosthetic hip. The purpose of this study was to examine HA use by measuring the amplitude of the electromyographic (EMG) signal from the HA muscles as subjects carried a load and simultaneously used a cane. SUBJECTS: Twenty-four active subjects (mean age = 63.3 years, SD = 10.7, range = 40-86) with a unilateral prosthetic hip were tested. METHODS: The HA muscle surface EMG activity was analyzed as subjects carried loads weighing 5%, 10%, or 15% of body weight held by either their contralateral or ipsilateral arm relative to their prosthetic hip. They simultaneously used a cane with their free hand. RESULTS: The contralateral cane and ipsilateral load conditions produced HA muscle EMG activity that was approximately 40% less than the EMG activity produced while walking without carrying a load or using a cane. CONCLUSION AND DISCUSSION: People who are in danger of premature loosening of their prosthetic hip should, if possible, avoid carrying loads. If a load must be carried, however, then the contralateral cane and ipsilateral load condition appears to minimize the loads placed on the prosthetic hip due to HA muscle activity.

Adult↗
PubMedDate not supplied

Three-year prospective study of developmental dysplasia of the hip at birth: should all dislocated or dislocatable hips be treated?

This article presents a 3-year prospective study that includes 103 consecutive patients (137 hips) diagnosed with developmental dysplasia of the hip (DDH) at birth. Treatment was started after 2 weeks only if the hips had not stabilized spontaneously. Sonographic studies were first used when clinical stability was confirmed to ensure a true concentric hip reduction. The authors conclude that most patients with DDH at birth (73.8%) do not need treatment at that time, presenting with normal hips at the end of follow-up. When instability was still present after 2 weeks and a splint was applied (26.2%), there were no significant hip differences when compared with a control group of 50 patients (69 hips) who underwent treatment in the first days of life. With this approach, the authors could safely reduce the number of patients to be treated, the amount of sonographic studies, and consequently the final cost of the whole treatment.

Age Factors↗
PubMed2004

Hip arthroplasty after extracapsular hip fracture: a matched pair cohort analysis.

Eighteen patients with a prior intertrochanteric or basicervical hip fracture had a total or bipolar hip arthroplasty. The clinical and radiographic results of these patients were compared to a control group of patients (matched for age, gender, associated diagnoses, and length of follow-up) who had a primary total hip arthroplasty. There was a significant increase in intraoperative blood loss, operative time, and number of units of blood transfused in the fracture group compared to the primary arthroplasty group. The mean preoperative Harris hip scores were not significantly different between the two groups, but the postoperative scores were significantly lower for the fracture group (p < .001). There was no notable difference in the rates of radiographic loosening or heterotopic ossification between the two groups. The results of this study suggest that patients should be counseled preoperatively that the functional outcome of hip arthroplasty after internal fixation of extracapsular hip fractures is decreased compared to control patients with a primary total hip arthroplasty.

Adult↗
PubMed1991

[Ultrasonography of the borderline between normal and pathological state of the hip in newborn infants (borderline hip)].

Infant hips are classified, according to Graf, in 4 US types on the basis of the morphologic changes in both the cartilaginous and the bony roofs (type I, II, III, IV). Out of 6,000 examined hips, 170 (2.8%) were considered, which could be classified neither as type I (mature) nor as type II (delayed/immature ossification). These hips were called borderline hips. They exhibited some characteristic US features: good bone modeling, rounded cotyle, and alpha angle 60 degrees +/- 2. They were always observed during the first month of the patients' life. Anamnestic data were not specific (27.5% breech delivery, and 13% oligohydramnios); clinics sometimes overestimated the actual anatomic development (64/170 cases with positivity of Ortolani's sign and/or restricted abduction; 25% of patients presented with no suspicious signs). Dynamic hip examination showed only physiological cranial deflection of the cartilaginous roof. Finally, borderline hips developed into type I hips in 99% of cases, within the third month of the patients' life.

Follow-Up Studies↗
PubMed1987

[Does the IIa hip need treatment? Results of a longitudinal study of sonographically controlled hips of infants less than 3 months of age].

In a randomized retrospective study we followed hips classified as Type II a by ultrasound. The classification as "Type IIa" only was found inadequate. It is important to further differentiate the so-called physiologically immature hip, namely to distinguish between joints that, while immature, are appropriate for age [Type IIa(+)], and those hips with a maturation deficit exceeding a tolerable degree [Type IIa(-)]. The follow-up showed that hips classified as Type IIa(-) and treated before the age of 6 weeks had a clearly better healing result than the hips treated only after the sixth week. Thus, to achieve optimal healing and to keep to a minimum the dysplasias requiring treatment after 3 months' age, an ultrasound study of the hip should be done as early as possible. The total percentage of ultrasonically recognized abnormal joints requiring treatment (independently of the patient's age) was 6.6%. This corresponds to the regional average before the advent of ultrasound. However, because of extensive very early screening in our area, we found not a single hip dislocation later then at the age of 10 weeks during the last 2 years.

Hip Dislocation, Congenital↗