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PubMed2001

Concentration and localization of YKL-40 in hip joint diseases.

OBJECTIVE: YKL-40 is a major secretory protein from human chondrocytes and synovial fibroblasts. We evaluated the concentrations and localization of YKL-40 in hip joint diseases, and analyzed the possibility of YKL-40 as a new inflammatory joint marker. METHODS: The concentration of YKL-40 in synovial fluid (SF) was measured by a sandwich-type ELISA. SF samples were collected from 19 hips with osteoarthritis (OA) of the hip joint, 21 hips with osteonecrosis of the femoral head (ONFH), and 5 hips with failed total hip arthroplasty (failed THA). In all cases of failed THA, cartilage tissue in hip joints was removed completely during the previous THA. The localization of YKL-40 was determined through immunohistochemical analysis using a specific antibody. RESULTS: The mean SF concentration of YKL-40 was significantly higher in ONFH and failed THA than in OA. Comparison by OA grade was not significantly different. In staging of ONFH, Ficat stage III with collapsed femoral head showed significantly higher YKL-40 concentrations than the other stages. Immunohistochemical studies showed that YKL-40 was localized in chondrocytes in the superficial and middle layers of the cartilage. In the synovium, YKL-40 was localized in fibroblasts and macrophages. CONCLUSION: YKL-40 reflects the degree of inflammation rather than cartilage metabolism. YKL-40 may be a useful inflammatory marker of hip joint diseases.

Adipokines↗
PubMedDate not supplied

Arthroscopy of the hip joint: an overview.

Hip arthroscopy is a procedure that is gaining popularity for treating hip pain related to intraarticular cartilage lesions or loose bodies. It offers an alternative procedure that can decrease or eliminate hip pain and increase a patient's ability to do activities of daily living. This article provides a comprehensive overview of hip arthroscopy and also addresses the anatomy of the hip, appropriate diagnoses for the procedure, operative considerations and postoperative teaching.

Activities of Daily Living↗
PubMed1975

Ultrastructure of canine articular cartilage: comparison of normal and degenerative (osteoarthritic) hip joints.

Normal canine hip cartilage was compared with cartilage from the degenerative lesions found in young dogs with canine hip dysplasia. The upper 0.5 mm of normal cartilage was characterized. Four distinct layers or zones were found: a layer of fine fibrous material covering the surface, a layer (surface layer) of small (32 nm diameter or less) collagen fibrils tightly packed in bundles and oriented parallel to the surface, a layer (upper layer) or less tightly packed collagen fibrils oriented mostly parallel to the surface with about 33% of the fibrils 64 nm or more, and a layer (intermediate layer) of randomly oriented fibrils with more than 50% of the fibrils 64 nm or larger. Fibril density was high in the surface layer and decreased with depth into the cartilage. In a moderately advanced lesion of degenerative cartilage, there was a layer of amorphous material over the surface. The tightly packed surface layer of small fibrils was absent. The surface itself was uneven and fissued. At depths from the surface comparable to the upper and the intermediate layers in normal cartilage, the proportion of large fibrils was less than in normal cartilage. The overall density of fibrils in degenerative cartilage increased with depth into the tissue. Cells flattened parallel to the surface, with relatively large nuclei, were found in the upper layer of normal cartilage. Cells in the intermediate layers were larger and round. The oblong cells of the upper layer of normal cartilage were not found in any layer of degenerative cartilage. Differences between cells in other layers of normal and degenerative cartilages were minimal. A model for the arrangement of chondrocytes and collagen fibrils for normal and degenerative cartilage was proposed. Ultrastructural changes in degenerative cartilage were prominent in the upper 0.5 mm of cartilage. These changes were changes in the number of collagen fibrils/mum-2 and a change from a characteristic pattern of collagen fibril diameters and orientation found in normal tissue.

Animals↗
PubMedDate not supplied

Surface replacement of the hip joint.

A total hip resurfacing prosthesis consisting of a high density polyethylene socket and a stainless steel cup was devised in 1974. Bone cement fixes the socket in the acetabulum but is not applied between the cup and the femoral head. Four types of sockets and 3 types of femoral cups with different diameters are available. Between April 1974, and October, 1977, 57 total hip replacements using socket-cup prosthesis were performed in 54 patients with various hip disorders. In this series, 36 patients with 37 of these replacements ranging in age from 40 to 68 years (mean 50 years) were examined. The length of follow-up ranged from 6 months to 3 1/2 years and the overall subjective and objective results were excellent. Pain was relieved in 97.3%. Walking ability was improved in 86.1%. With 6 months in almost all patients, mobility and the activities of daily living were significantly improved.

Adult↗
PubMed1993

Arthroscopic diagnosis and treatment of septic arthritis of the hip joint.

Septic arthritis of the hip joint can be difficult to detect clinically and usually requires a formal arthrotomy for adequate drainage and debridement of the joint. This case report presents a patient for whom the diagnosis and treatment were performed arthroscopically. This technique allows isolation of the organism as well as the opportunity to irrigate, lavage, and debride the joint through a small puncture wound only.

Adult↗
PubMed2006

Effect of obesity on posture and hip joint moments during a standing task, and trunk forward flexion motion.

OBJECTIVE: Effects of obesity on trunk forward flexion motion in sitting and standing, and postural adaptations and hip joint moment for a standing work task. DESIGN: Cross-sectional comparison of obese and normal weight groups. SUBJECTS: Ten obese subjects (waist girth 121.2+/-16.8 cm, body mass index (BMI) 38.9+/-6.6 kg m(-2)) and 10 age- and height-matched normal weight subjects (waist girth 79.6+/-6.4 cm, BMI 21.7+/-1.5 kg m(-2)). METHODS: Trunk motion during seated and standing forward flexion, and trunk posture, hip joint moment and hip-to-bench distance during a simulated standing work task were recorded. RESULTS: Forward flexion motion of the thoracic segment and thoracolumbar spine was decreased for the obese group with no change in pelvic segment and hip joint motion. Obese subjects showed a more flexed trunk posture and increased hip joint moment and hip-to-bench distance for a simulated standing work task. CONCLUSIONS: Decreased range of forward flexion motion, differing effects within the trunk, altered posture during a standing work task and concomitant increases in hip joint moment give insight into the aetiology of functional decrements and musculoskeletal pain seen in obesity.

Adult↗
PubMed2002

Infiltration of sarcomas into the hip joint: comparison of CT, MRI and histologic findings in 67 cases.

We analyzed the incidence, route, and characteristics of hip joint infiltration in pelvic or proximal femoral sarcomas. 67 patients with a sarcoma that originated around the hip joint (50 pelvic and 17 femoral) were included in this study. Preoperative CT and MRI were matched with the histological findings in tumor specimens. Tumor infiltration into the hip joint was suspected on the basis of preoperative imaging in 29 patients due to articular cartilage disruption, diffuse signal changes in the acetabulum or femoral neck, signs of a tumor in the joint, or markedjoint effusion. Of these 29 patients, 15 showed tumor invasion on histological examination. 12 of 31 chondrosarcomas, none of 12 Ewing's sarcomas, and 3 of 24 osteosarcomas infiltrated into the hip joint (p = 0.008). 10 of 26 low-grade sarcomas and 5 of 41 high-grade sarcomas infiltrated into the hip joint (p = 0.02). The joint infiltration rate of the chondrosarcomas was related to their size. Of 10 tumors originating in the acetabulum, 9 penetrated through or around the osseous-ligamentous junction and one through the acetabular cartilage. In 5 proximal femur lesions, all infiltrated the joint through the femoral neck, 3 of them also through the ligamentum teres.

Adolescent↗
PubMed2005

Evaluation of a new algorithm to determine the hip joint center.

Accurately locating the hip joint center is a challenging and important step in many biomechanical investigations. The purpose of this study was to test the accuracy and robustness of a "pivoting" algorithm used to locate the hip center. We tested the performance of this algorithm with data acquired by manipulating a ball and socket model of the hip through several motion patterns. The smallest mean errors of 2.2+/-0.2 mm occurred with a circumduction motion pattern, while the largest errors of 4.2+/-1.3 mm occurred with single-plane motion (e.g., flexion/extension). Introducing random noise with an amplitude of 30 mm increased the errors by only 1.3+/-0.5 mm with a circumduction motion pattern. The pivoting algorithm performs well in the laboratory, and further work is warranted to evaluate its performance in a clinical setting.

Algorithms↗
PubMed2004

[Bilateral ankylosing paraarticular ossifications of the hip joint with involvement of the sciatic nerve].

In December 1997 a 48 year-old man was treated by resection of the bilateral paraarticular ankylosing ossifications that developed after 6 weeks of unconsciousness after necrotic pancreatitis. The ossifications on the posterior part of the hip joint involved a highly separated sciatic nerve. There was a bilateral osseous ankylosis of the hip joint and total denervation of sciatic nerve. In April 1999 the ossifications on the right side were removed. The splitted sciatic nerve was in two osseous channels. The head of the femur was vital and immediately following the operation, flexion of the hip joint was possible to 90 degrees. The same procedure was performed on the left hip joint in October 1999. In April 2000, a re-occurance of the paraarticular ossification on the ventral part of the right hip joint was removed from an ilioinquinal approach. In June 2002 the patient was able to stand and walk without crutches. ROM of the knee joints improved bilaterally to 120 degrees of flexion. The flexion of the right hip joint is 70 degrees and in the left hip is 80 degrees. 3 years after decompression of both sciatic nerves involved in heterotopic bone established significant reinervation. The motor function of the proximal femoral muscles and the function of the tibial nerve was renewed. Complete motor denervation syndrom persists in common peroneal nerve. Sensitive inervation was renewed as in n. tibialis as in common peroneal nerve except acral parts of the foot a toes. Concerning function of the sciatic nerves, the overall results can be assessed as partially succesfull because of partial denervation syndrome of sciatic nerves. In definite clinical improvement the recovery of the neurologic status is very important besides the mechanical improvement of range of motion of the hip joint.

Ankylosis↗
PubMed1997

Ultrasonography in the early diagnosis of hip joint involvement in juvenile rheumatoid arthritis.

OBJECTIVE: To determine the value of ultrasonography in detection of early alterations and subsequent evolution of hip joint disease in patients with juvenile rheumatoid arthritis (JRA). METHODS: Hip joints of 53 patients were evaluated clinically, by conventional radiography and ultrasound. Ten children free of signs/symptoms related to rheumatic diseases were chosen as a control group. Nine patients were followed up 28 months after baseline examinations. The clinical, radiological, and ultrasound evaluations were repeated. RESULTS: Conventional radiography showed alterations in 10 patients (18.9%) who had shown clinical manifestations of advanced disease of the hip joint while ultrasound detected abnormalities in asymptomatic patients who had had normal radiographs. Ultrasound revealed the occurrence of 47.2% involvement in the hips of patients with JRA. Thus, ultrasound was apparently more sensitive than conventional radiographs in diagnosing changes in the hip joints of patients with JRA. Further, such involvement was found with greater frequency in the systemic and polyarticular types of JRA, in children less than 5 years of age, in those with longer duration of disease, and in those who belonged to a poorer functional class. In 3 of 9 patients who initially had normal radiographs and altered ultrasound, we found severe hip alterations upon reevaluation by radiography, after a period ranging from 21 to 39 months. CONCLUSION: Ultrasonography is a method of diagnosis that must be considered in hip joint evaluation of patients with JRA.

Adolescent↗
PubMed2005

[The hip joints of preterm neonates in sonographic evaluation].

The introduction of sonography to the evalution of the hip joint, allowed for the non-invasive examination in preterm neonates and thus assessment of the development their hip joints. MATERIAL AND METHODS. The examined group consisted of 143 preterm neonates with the body weight by delivery lower then 2000 grams (286 hip joints) and the control group of 31 children from term delveries forming the control group. The sonographic examination was conducted stricktly according to the rules presented by Graf. First examination was performed averagely in the 3rd week of life, second avg. in the 14th, third in avg. the 23rd, fourth avg inthe 33r week of life. Wyniki. In the first examination, done in the 3rd week of life it was noticed that highest rate of the hips Ia appeared in the group I (newborns with the lowest bogy weight), and together with the increase in body weight the incidence of such hips decreased, when the incidence of type IIa hips increased at the same time. At the final examination no statistically significant differences were found between the hip joints and no dysplastic hips were found. Wnioski. According to our results, we found that preterm delivery is not a risk factor for the developmetal hip dysplasia.

Female↗
PubMed2006

Effects of movement for estimating the hip joint centre.

Determination of the hip joint centre (HJC) using a functional approach requires access to the kinematics of various body postures. The present study aimed to determine the combined impact of the nature of the movement, its type and the number of cycles, on the accuracy of HJC estimation. Kinematics noise was modelled based on the deformation of hip and thigh clusters of seven subjects, while perfect ball-and-socket movements (used as reference) were calculated based on the movements of one of the subjects. The noise added to the reference kinematics allowed the simulation of 27 tests. Errors were defined as the Euclidean distance between the estimated and the reference HJC. A nested ANOVA and a multiple comparison procedures were performed on all errors. A test including 10 cycles of three different types of limited movements (flexion-extension, abduction-adduction and circumduction) yielded the greatest accuracy for estimating HJC (4.0+/-1.3 mm). Combining different types of movements allowed improving the accuracy. Given that noise increases as a function of the range of a motion, limited movements proved to be the most accurate; however, 10 cycles were required to achieve such results. For trials involving a single cycle, a large movement proved more efficient.

Adult↗
PubMed1995

Gas bubbles in the hip joint on CT: an indication of recent dislocation.

OBJECTIVE: The purpose of this study was to determine if gas bubbles in the hip joint seen on CT scans after trauma are reliable indicators of recent (< 48 hr) hip dislocation. We believe that the gas seen in the hip joint represents intracapsular nitrogen bubbles that result from the vacuum created by forcible distraction associated with traumatic dislocation. MATERIALS AND METHODS: CT scans of 79 consecutive patients with pelvic injury were reviewed retrospectively. We noted the number and position of intracapsular gas bubbles, presence of joint effusion, soft-tissue injury, and associated fractures or dislocations. Intracapsular gas bubbles were defined as round areas of low attenuation, in an intracapsular position, that on visual inspection were equivalent to air. Seventy-three of 79 patients were imaged within 48 hr of injury. Most patients had been involved in a motor vehicle collision or were pedestrians struck by a motor vehicle. Fifteen patients had hip dislocation, including one patient with bilateral dislocation. Fifty-five patients had pelvic fractures without hip dislocation, and nine patients had soft-tissue injury without fracture or dislocation. Fourteen of 16 dislocations had been reduced at the time of scanning. RESULTS: Gas bubbles were seen in the hip joint on CT scans in 13 (81%) of the 16 dislocated hips, including 12 (92%) of 13 dislocations in patients scanned within 4 hr of admission. Bubbles were present in 11 (79%) of 14 hip joints that had dislocations reduced at the time of scanning and in both hip joints that remained dislocated. Most bubbles were located anterior to the femoral neck; however, bubbles were also seen posteriorly. Bubble size (1-3 mm) and number (1-7) varied. Only two (3%) of 64 patients without dislocation had intracapsular gas bubbles; one had been shot and the other had extensive soft-tissue emphysema. CONCLUSION: In the absence of penetrating trauma, intracapsular gas bubbles on CT are reliable indicators of recent hip dislocation and may be the only objective finding of this injury.

Accidents, Traffic↗
PubMed2001

[The Zweymuller endoprosthesis in hip joint revision surgery].

PURPOSE OF THE STUDY: The aim of the study is the verification of the applicability of the Zweymüller system of total hip replacement in dependence on the size of defects of acetabulum and femur and evaluation of early results in patients operated on in 1998 and 1999. MATERIAL: In 1998 and 1999 we reimplanted 125 total hip replacements. In 60 revision surgeries we used at least one component of Zweymüller Bicon Plus system. We prospectively followed defects of acetabulum and femur in DGOT classification. The size of the stem was planned, final indication of the cup was determined peroperatively. METHODS: During the implantation of the cup we tried to achieve primary stability of the implant. The cup was implanted in uni- and bisegmental defects. In total we implanted 50 Bicon cups, in 24 hip joints we applied morselized allograft in the defect. In tri-segmental defects we used twice the Burch Schneider cage and in 4 hip joints a bone allo-graft with a cemented cup in combination with SL-Plus stem. In one female patients after the implantation of Bicon cup in type 7 defect there occurred an early failure. When removing bone cement we preferred fenestration of the cortical bone of the femoral shaft. In 30 hips SL-Plus stem was used and in 13 hip joints SLR-Plus was applied. We checked 50 hip joints operated on by the method after Harris and by radiographs in two projections. RESULTS: Fifteen patients are without pain, 14 patients take analgesics. The final result is excellent in 24% of patients, good result in 32%, satisfactory in 24% and poor in 20% of patients followed up. By comparison with HHS value prior to the surgery HHS got worse in two patients who are not satisfied with the result of the operation. Average score prior to surgery was 47.4 points (range, 23-82.6). Five times we encountered a radioluscent line of acetabular component in zone III. Radiograph signs of loosening of the cup or stem were not found in any of the hip joints. CONCLUSION: Zweymüller system is applicable in revision surgeries of both cemented and cementless hip joint replacements. The cup may be applied in uni-segmental and bi-segmental acetabular defects under the condition of achievement of primary stability. Applied morselized bone allografts have a good potential for osteointegration and remodeling. The rectangular stem is suitable for the treatment of defects extending as far as 5 cm below the level of lesser trochanter. Bone cement was extracted from fenestration, transfemoral approach was not required in any of the patients. Even with the use of SLR (revision) stem we did not transfer fixation of the femoral component to the lower half of femur.

Acetabulum↗
PubMed1979

Serum enzymes after hip joint surgery.

The effect of hip joint surgery on routine serum enzyme values was studied. The increase in creatine kinase was most marked and normal levels were restored again after approximately 1 week. Asparatate aminotransferase was slightly elevated throughout the first two postoperative weeks. Alanine aminotransferase was essentially unchanged during the first three postoperative days in contrast to lactate dehydrogenase which reached preoperative values again after only 2--3 days. Alkaline phosphatase showed an increase after 1 week whereas S-amylase was essentially normal throughout the 2 weeks studied.

Adult↗
PubMed1990

[Resection of the obturator nerve for analgesic treatment of degenerative-deforming changes of the hip joint].

Resection of the obturator nerve in hip joint arthritis can eliminate or decrease pain depending on the obturator nerve share in the hip joint innervation. From 1986 to 1988 34 obturator neurectomies were performed in painful hip arthritis patients with temporary or permanent contraindications for hip arthroplasty. In 21 from 30 patients followed-up at least 3 months partial or total relief of pain was found. Extrapelvic obturator neurectomy technique and indications for this procedure were presented.

Adult↗
PubMed1991

Four-channel telemetry system for in vivo measurement of hip joint forces.

The long-term loosening of artificial hip joints remains a serious clinical problem. Optimization of implant design and material will improve the fixation, but it requires a detailed knowledge of the forces which act on the implant. A four-channel telemetric transmitter was developed and arranged completely inside a hermetically closed artificial hip joint. This permits long term in vivo measurements of the three-dimensional forces without endangering the patient. The external telemetry system consists of an inductive power supply, an RF receiver, a microcomputer with hardware extension and a VHS video system. The personal computer offers real-time data processing of three orthogonal force components as well as slow motion analysis of recorded measurements. After several years of animal tests, two instrumented prostheses were implanted in the first patient (male) in May and August of 1988. In March 1990 a third prosthesis was implanted in a second patient (female). Joint force measurements have regularly been performed from the first post-operative day until now for several kinds of activity.

Biomechanical Phenomena↗
PubMed2003

Tantalum as a buffer layer in diamond-like carbon coated artificial hip joints.

The acid resistance of tantalum coated and uncoated human hip joint prostheses was studied with commercial CrCoMo acetabular cups. The samples were exposed to 10% HCl solution and the quantities of dissolved Cr, Co, and Mo were measured with proton-induced X-ray emission (PIXE). The absolute quantities were obtained with the use of Cr and Se solution standards. Tantalum coatings (thicknesses 4-6 microm) were prepared in vacuum with magnetron sputtering. Tantalum coating decreased the corrosion rate by a factor of 10(6). As a spinoff from recent wear tests on artificial hip joints it was shown that tantalum has excellent mechanical properties as an intermediate layer of diamond-like carbon (DLC) coatings. When tantalum was tested together with DLC on three metal-on-metal hip joint pairs in a hip simulator, no observable defects occurred during 15 million walking cycles with a periodic 50-300-kg load (Paul curve).

Acids↗