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PubMed1982

Hip dysplasia associated with abduction contracture of the contralateral hip.

Eighteen children with unilateral dysplasia of the hip were found to have asymmetrical gluteal folds and an apparent limb-length inequality secondary to pelvic obliquity caused by an abduction contracture of the contralateral hip. The dysplastic hip was on the left in all but one patient. As a result of the pelvic obliquity, the femoral head on the high side of the pelvis was directed superolaterally, stretching the relaxed capsule still farther. The femoral head was then not concentrically reduced, and the pressure it caused on the superior border of the labrum contributed to the development of the acetabular dysplasia. The eighteen dysplastic hips were treated with abduction splinting and stretching exercises of the contralateral hip to decrease the abduction contracture. All of the dysplastic hips returned to a normal roentgenographic appearance with this treatment. Acetabular dysplasia without dislocation of the hip is not always appreciated by clinical examination, but the asymmetry of the gluteal folds and the apparent limb-length inequality that were seen in all of the children in this series were obvious clinical signs. These findings must be differentiated from the anterior thigh-fold asymmetry that is frequently seen without underlying pathology.

Braces↗
PubMedDate not supplied

Histologic, histochemical, and ultrastructural studies of the hip joint capsule and ligamentum teres in congenital dislocation of the hip.

The histology, histochemistry, and ultrastructure were investigated in 12 ligamentum teres and 11 hip joint capsule biopsies obtained at open reduction of 9 patients with congenital dislocation of the hip (CDH) and of 2 normal hips. The ages of the patients ranged from 2 months to 4 years and 2 months. In the joint capsule of the dislocated hips, the cells were irregularly distributed, had different shapes, and appeared to be in different stages of functional activity. The collagen fiber bundles were thicker than in the normal capsule, distributed and of varied thickness. The collagen fibrils in the younger patients were thinner than in the normal hip and their diameter increased slightly with age. In the ligamentum teres of the dislocated hips the elastic fibers were thicker and more numerous than in the normal hip, whereas the cells and collagen fibrils showed changes similar to those observed in the capsule. Fibrocartilaginous metaplasia was found in both the capsule and the ligamentum teres in areas compressed by the femoral head. The morphologic and histochemical changes observed in the joint capsule in CDH appeared to be secondary to the mechanical stresses caused by the dislocation.

Cartilage, Articular↗
PubMed1994

Autophor cementless total hip arthroplasty for osteoarthrosis secondary to congenital hip dysplasia.

The authors present a consecutive series of 38 arthroplasties for osteoarthrosis secondary to hip dysplasia. All arthroplasties were performed by a single surgeon using Mittelmeier II (Autophor, Osteo AG, Selzach, Switzerland) ceramic cementless components. Crowe grades of subluxation were 60% grade I, 16% grade II, 12% grade III, and 12% grade IV. In all cases, the acetabular component was seated in the true acetabulum. The mean follow-up period was 75 months (range, 40-122 months). By the time of review, six hips (16%) had required revision for aseptic loosening, mainly of the femoral component. Good or excellent results were achieved in only 63% of the patients. In the group of surviving arthroplasties, the median Charnley hip scores before surgery were: pain, 2; movement, 3; and walking, 3. After surgery, the scores were: pain, 5; movement, 5; and walking, 6. All improvements were significant. The mean postoperative Harris hip score was 84. Poor scores were associated with contralateral hip disease (2 cases) and spina bifida (2 cases), significantly affecting function. The Autophor prosthesis can produce satisfactory results in some of these young patients with hip dysplasia. However, femoral loosening is a major problem and because of this, the authors have since changed to a newer stem design.

Adult↗
PubMed1998

Long-term trends in hip fracture prevalence: the influence of hip fracture incidence and survival.

In this population-based descriptive study covering the 65-year period, 1928-92, there was a 5-fold increase in hip fracture prevalence among Rochester, Minnesota residents between 1928-42 and 1973-82, from 135.8 to 675.8 per 100,000. This change was dictated almost entirely by an increase in the incidence of first hip fractures due to moderate trauma (n = 2058) that was observed among Rochester women through 1950, and among men through 1980, that affected all age groups. Declining incidence rates thereafter led to a 9% fall in hip fracture prevalence from 1973-82 to 1983-92 to a rate of 612.7 per 100,000. A 13.7-year increase in age at first hip fracture over the study period was accounted for by aging of the underlying population, and a comparable 13.9-year increase in the age at death following hip fracture appeared to result from improved survival in the population generally. Thus, trends in hip fracture prevalence were mainly determined by changes in incidence rather than relative changes in age at onset and death following hip fracture.

Adult↗
PubMed2006

Role of hip arthroscopy in the diagnosis and treatment of hip joint pathology.

PURPOSE: Hip arthroscopy is growing in importance and relevance in the detection and treatment of various pathologies affecting the hip joint. There are a number of indications, including diagnosis and treatment of labral tears, extraction of loose bodies, and synovial-based diseases. Reports in the literature cite few complications arising from this minimally invasive procedure in a joint that has been difficult to access. The purpose of our study was to assess the efficacy and role of hip arthroscopy in the management of hip joint pathology. TYPE OF STUDY: Retrospective review of a consecutive series of 22 patients over a 44-month period. METHODS: The indications for surgery included ongoing hip pain for more than 6 months. Sixteen patients underwent contrast-enhanced magnetic resonance imaging scans, including all patients with mechanical symptoms. The procedure was performed as day surgery and all the patients were available for follow-up. They were assessed for pain, mechanical symptoms, activity levels, and sporting activities. RESULTS: All patients were assessed by means of a questionnaire and allocated scores out of a maximum of 100 points. The most significant improvement was seen in the group of patients (n = 10) who had mechanical symptoms with definite labral pathology confirmed and treated arthroscopically. Their scores improved from an average of 64 preoperatively to 90 postoperatively. There were no complications in our series. CONCLUSIONS: Hip arthroscopy represents an effective tool in treating hip joint pathology with reasonable expectations of success and a minimal complication rate. LEVEL OF EVIDENCE: Level IV.

Adolescent↗
PubMed1998

Hip motion and moments during gait relate directly to proximal femoral bone mineral density in patients with hip osteoarthritis.

The present study examined the loads at the hip joint during gait and the bone mineral density of the proximal femur in 25 patients with end-stage hip osteoarthritis. Dual energy X-ray absorptiometry was used to determine the bone mineral density of the greater trochanter, femoral neck and Ward's triangle of the osteoarthritic group. The bone mineral density was normalized for the patient's age, gender, weight and ethnic origin (Z score). Gait analysis was used to determine the external hip joint moments and motion during walking for the osteoarthritic group and a control group of 21 normal subjects. The gait parameters of the osteoarthritic group which were significantly diminished compared to the normal group (p < 0.001) accounted for as much as 42% (p < 0.001) of the variation in the normalized bone mineral density. Specifically, the dynamic sagittal plane hip motion during gait (maximum flexion minus maximum extension) and peak external rotation and adduction moments were significantly correlated with greater trochanter (R = 0.429-0.648, p = 0.032-0.0001) and Ward's triangle (R = 0.418-0.532, p = 0.038-0.006) normalized bone mineral density while the adduction moment was also significantly correlated with the femoral neck normalized bone mineral density (R = 0.5394, p = 0.005). The normalized bone mineral density of the femoral neck and Ward's triangle was elevated while that of the greater trochanter was decreased as compared to normal reference values. The significant correlation between the hip joint moments during gait and femoral bone mineral density indicate that hip joint loads need to be included when explaining local variation in bone mineral density in hip osteoarthritis.

Absorptiometry, Photon↗
PubMedDate not supplied

[The problem of comparability of results of the treatment of congenital hip dislocation--exemplified by the Severin scheme and the classification system of the Work Group Hip Dysplasia].

The comparison of the results obtained by conservative or operative treatment of hip dysplasia shows that the consideration of absolute roentgenologic hip parameters is of little use. Classification principles for numerous hip parameters have been developed for this reason by Tönnis. In the Angloamerican and Scandinavian countries, on the other hand, it is predominantly the Severin classification that is employed for an evaluation of the methods of treatment. We examined in our study the differences in the evaluation of the results obtained in 117 hip joints treated by pelvic osteotomy according to Salter by application of the AKH and the Severin classification scheme. There were evident differences in all groups of these classifications. In the application of the Severin scheme the groups I, II and III contained 9.5% less, 24.8% more, and 18.8% less hip joints, respectively than in the respective groups of the Tönnis classification. In the groups IV, V and VI of the Severin classification there were altogether 3.5% less hip joints than in the respective groups of the Tönnis classification. Our study thus showed that a comparison of the operative results of hip dysplasia as presented in the Angloamerican and Scandinavian literature and those presented in the German literature is not possible. We conclude from this result that an evaluation according to a unified classification scheme would be most desirable.

Adolescent↗
PubMed1994

Risk factors for hip fracture in black women. The Northeast Hip Fracture Study Group.

BACKGROUND: Although more than 1 percent of black women 80 years of age or older have hip fractures each year, little is known about risk factors for hip fracture in these women. METHODS: We carried out a case-control study involving 144 black women admitted with a first hip fracture to 1 of 30 hospitals in New York and Philadelphia. The control were 218 black women living in the community who were matched to the case patients according to age and ZIP Code or telephone exchange and 181 hospitalized black women matched according to age and hospital. Information was obtained through personal interviews and was studied by multivariable logistic-regression analysis. RESULTS: When the case patients were compared with the control subjects from the community, the women in the lowest quintile for body-mass index had a markedly increased risk of hip fracture as compared with the women in the highest quintile (odds ratio, 13.5; 95 percent confidence interval, 4.2 to 43.3). Postmenopausal estrogen therapy for one year or more was protective for women under 75 years of age (odds ratio, 0.1; 95 percent confidence interval, < 0.1 to 0.5). Factors associated with an increased risk of hip fracture included a history of stroke (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.1), use of aids in walking (odds ratio, 5.6; 95 percent confidence interval, 2.7 to 11.5), and consumption of seven or more alcoholic drinks per week (odds ratio, 4.6; 95 percent confidence interval, 1.5 to 14.1). The results were similar when the case patients were compared with the hospitalized control subjects. CONCLUSIONS: Among black women thinness, previous stroke, use of aids in walking, and alcohol consumption are associated with an increased risk of hip fracture. Postmenopausal estrogen therapy protects against hip fracture in women under 75 years of age.

Aged↗
PubMed2003

Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged.

Disability attributable to hip fracture regarding activities of daily living was evaluated by comparing 594 hip fracture patients entering eight hospitals in Baltimore, Maryland, in 1990-1991 with community-dwelling aged from the Established Populations for Epidemiologic Studies of the Elderly (EPESE) cohort matched on age, sex, and walking ability. Subjects were assessed at baseline (prefracture report for patients), 12 months, and 24 months. At baseline, 26% of both groups had walking disability, 12-14% had transferring disability, and 6-8% evidenced grooming disability. At 12 and 24 months, about 50% of hip fracture patients were walking disabled compared with 21-29% of EPESE respondents after the authors controlled for age, sex, comorbidities, and functional status (excess disability attributable to hip fracture, i.e., attributable disability, of 26 additional cases of disability per 100 persons in the hip fracture cohort during follow-up). Likewise, hip fracture patients experienced more disability regarding transferring (38-39% vs. 10-18%; attributable disability, approximately 22 cases per 100 persons) and grooming (17-19% vs. 7-15%; attributable disability, approximately six cases per 100 persons). Thus, results showed that hip fracture patients had substantially more activities of daily living disability than that explained by aging over 24 months.

Activities of Daily Living↗
PubMed1996

Hip abductor muscle activity in persons with a hip prosthesis while carrying loads in one hand.

BACKGROUND AND PURPOSE: Carrying loads in one hand may result in the hip abductor (HA) muscles needing to generate large forces. For a person with a prosthetic hip, these forces may contribute to loosening of the implant. In this study, surface electromyography (EMG) was used to estimate the relative demands placed on the HA muscles as persons with a prosthetic hip carried loads in one hand. SUBJECTS: Twenty-five active subjects (9 female, 16 male) with a prosthetic hip participated. Subjects were aged 40 to 86 years (mean = 63.7, SD = 10.7). METHODS: Surface EMG data from the HA muscles (primarily the gluteus medius) were analyzed during mid-stance as subjects carried loads weighing 5%, 10%, and 15% of their body weight. Loads were carried in the hand opposite the side of the prosthetic hip (contralaterally held loads) or in the hand on the same side as the prosthetic hip (ipsilaterally held loads). RESULTS: Results showed that the contralaterally held loads produced greater HA muscle EMG activity levels than no-load walking. The ipsilaterally held loads produced lower HA muscle EMG activity levels than no-load walking. CONCLUSION AND DISCUSSION: These EMG data, in addition to calculations using a simple biomechanical model, suggest that persons should use caution or avoid carrying loads in the hand on the side contralateral to their prosthetic hip.

Adult↗
PubMed2004

Treatment of developmental dysplasia of the hip with Pavlik harness: prospective study in Graf type IIc or more severe hips.

Successful treatment of developmental dysplasia of the hip (DDH) is associated with early diagnosis and appropriate treatment. In this prospective study, the results of the treatment with Pavlik harness followed by an abduction brace in patients with severe DDH were presented. Twenty-two hips of 18 patients with a mean age of 14.8+/-5.9 weeks (range, 6-26) when diagnosed were followed for an average of 24.2+/-10.8 months (range, 10-46). The hips were staged according to the classification of Graf with ultrasonography and Pavlik harness was instituted as the first line of treatment in all hips. If there was no improvement of ultrasonographic stage at the third week follow-up the harness treatment was discontinued. After the infant became too large for Pavlik harness an abduction brace was used. In all but one hip the treatment was successful (95.4%). In two hips type I avascular necrosis was noted. Of the dislocated hips 90% were reduced. The Pavlik harness is a safe and effective method of treatment of severe DDH in infancy if potential pitfalls are avoided.

Bone Diseases, Developmental↗
PubMed2002

Investigation of hip abductor activation in subjects with clinical unilateral hip osteoarthritis.

OBJECTIVES: (a) To compare the magnitude of gluteus medius and tensor fascia lata activation between a group of subjects with clinical unilateral hip osteoarthritis and a group of healthy older adults. (b) To compare the magnitude of activation of the gluteus medius and tensor fascia lata between sides in a group of subjects with clinical unilateral hip osteoarthritis and a group of healthy older adults. METHODS: 19 subjects with clinical unilateral hip osteoarthritis and 19 healthy controls were investigated. The subjects performed a stepping task during which recordings were obtained using surface electromyograms from the hip abductors, and kinetic data were obtained from a dual force platform. RESULTS: Subjects with clinical hip osteoarthritis had higher gluteus medius activation than the healthy older adults (p=0.037). In addition, there were no differences in the magnitude of gluteus medius activation between the sides (p=0.733). There was no difference in the force platform data between the groups (p=0.078). CONCLUSIONS: The increased magnitude of gluteus medius activation in the group with hip osteoarthritis is evidence of a muscular dysfunction associated with hip disease. This has implications for the progressive nature of the disease and for its conservative management.

Aged↗
PubMed1991

Ultrasonography in congenital dislocation of the hip. Simultaneous imaging of both hips from in front.

We describe a new technique for examining the infant hip using ultrasound. Both hips are imaged simultaneously via an anterior approach. The examination can be done with the hip either extended or flexed and abducted. The method has three advantages: 1) since both hips are imaged simultaneously, lines can be drawn to assist in determining the relationship between the femoral head and the pelvis; 2) proximal, anteroposterior and lateral displacement of the femoral head can all be demonstrated; 3) the method is applicable to the infant in a harness or a plaster cast to demonstrate maintenance of reduction of a dislocated hip. The usual direction of dislocation of the femoral head was anterior and lateral. Proximal migration was also observed in cases with more severe dislocation. In flexion, the dislocated head of the femur often moved posterior to the acetabulum. Of 1276 hips, in 638 infants aged from three weeks to one year, 49 showed congenital dislocation. The accuracy of our anterior method of sonography in diagnosing congenital dislocation of the hip compared well with the method of Graf and with radiography.

Female↗
PubMed1999

Is diagnostic arthroscopy of the hip worthwhile? A prospective review of 328 adults investigated for hip pain.

We describe a prospective study of 328 patients undergoing arthroscopy of the hip. Arthrography, CT or MRI was performed when clinically indicated. A preoperative diagnosis was reached in 174 patients (53%), while the remaining 154 were diagnosed as having 'idiopathic hip pain'. In seven patients, access to the hip was inadequate. Arthroscopy altered the diagnosis in 176 hips (53%). The new primary diagnoses were osteoarthritis (75 patients), osteochondral defects (34), torn labra (23), synovitis (11) and loose bodies (9). In 172 hips (52%) an operative procedure was undertaken. In the remaining 84 patients (26%), arthroscopy neither changed the diagnosis nor provided surgical treatment. Arthroscopy of the hip is considered to be of value in assessing and treating the adult patient with pain in the hip of uncertain cause.

Adolescent↗
PubMed2002

In vivo comparison of hip separation after metal-on-metal or metal-on-polyethylene total hip arthroplasty.

BACKGROUND: Twenty subjects were analyzed in vivo with use of video fluoroscopy to determine if the femoral head separates from the acetabular component during normal gait and to determine if the amount of separation differs between metal-on-metal and metal-on-polyethylene total hip prostheses. METHODS: Ten subjects had been treated with a metal-on-metal total hip arthroplasty and ten, with a metal-on-polyethylene total hip arthroplasty. All of the prostheses were implanted by the same surgeon utilizing the same surgical technique, and all were judged to be clinically successful (a Harris hip score of >90 points). Each subject walked with a normal gait on a level treadmill while under fluoroscopic surveillance. The two-dimensional fluoroscopic videotapes were then converted into three-dimensional images with use of a computer-automated model-fitting technique. Each implant was analyzed at various flexion angles to assess the amount of femoral head sliding. RESULTS: No femoral head sliding was observed in the subjects with a metal-on-metal implant, whereas all ten subjects with a metal-on-polyethylene implant had sliding that was greater than our threshold value of 0.75 mm. The average amount of femoral head sliding in these subjects was 2.0 mm, and the sliding was observed during the swing phase of gait. The sliding was typically seen medially while the femoral head remained in contact with the acetabular component superolaterally. CONCLUSIONS: Femoral head sliding commonly occurred following traditional metal-on-polyethylene total hip arthroplasty but not after metal-on-metal arthroplasty. These kinematic data may be of value in future hip-simulation studies to better duplicate wear patterns observed in retrieval analyses, assist in the understanding of the lubrication and wear rates of metal-on-metal designs, and facilitate designing of prosthetic components that minimize wear and optimize hip kinematics.

Acetabulum↗
PubMed1995

The role of hip arthroscopy in the diagnosis and treatment of hip disease.

Injuries to the hip are commonly encountered by orthopedic surgeons and will, for the most part, respond well to conservative therapy. When a patient's hip pain has not responded to the appropriate treatment and radiographic measurements have not shown any specific pathology, arthroscopy of the hip can be a valuable diagnostic and therapeutic procedure. We retrospectively reviewed 94 consecutive patients who experienced refractory hip pain that persisted longer than 6 months (average: 2.1 years) and who had an average follow up of 2.5 years. Statistical analysis was performed using Fisher's Exact Test (P value) and Pearson (r value) correlation coefficient to compare preoperative symptomatology and physical examination findings with intraoperative pathology. Statistically significant results were obtained when comparing preoperative symptoms of a painful hip click and mechanical symptoms of locking with acetabular labral injuries (P = .000, r = .896) and loose bodies (P = .000, r = .896), respectively. Radiologic studies were nondiagnostic in 76% of patients in this series. Hip arthroscopy can be a valuable and viable procedure in the diagnosis and treatment of protracted or progressive hip pain lasting more than 6 months.

Adult↗
PubMed2001

Varus derotation osteotomy for the treatment of hip subluxation and dislocation in cerebral palsy: statistical analysis in 73 hips.

The purpose of this study is to review the results of varus osteotomy in patients with cerebral palsy and to determine factors that influence the rates of residual hip displacement. A retrospective chart review of 65 patients who underwent 79 varus osteotomies was performed. Preoperative, postoperative and follow-up radiographs were analyzed for routine radiographic measurements, pelvic obliquity, osteonecrosis (avascular necrosis), joint incongruity or degenerative joint disease. The average follow-up was 5.2 years (range, 1.1-18.4 years). At follow-up, 3 hips were dislocated, 19 were subluxated and 57 were stable (72%). Age at surgery and the degree of preoperative hip displacement had significant effects on outcome. The average age at surgery for initially subluxated hips, which were located at follow-up, was 7.2 years. This was significantly younger (P = 0.008) than initially subluxated hips, which were displaced (10 years of age). Subluxated hips at surgery were also more likely to be located at follow-up than dislocated hips.

Adolescent↗
PubMed1990

Ipsilateral hip and femoral shaft fractures treated with compression hip screw and long side-plate.

Complex femoral fractures involving the hip and shaft are not rare findings in the emergency room. The primary problem in the care of these patients is the preservation of their lives. The fracture combination under discussion is only a part of the injury complex sustained by these individuals. After the acute problems have been brought under control, care of the fractured femur and hip must be planned. Recently, most centers have favored giving priority to hip fractures, rigid fixation and early mobilization. However, for the fixation implants, variable fixation methods have been reported but are imperfect. In the past 5 years we have had some experience using compression hip screws with long side-plate to fix the different injured parts of these dual shaft and hip fractures at the same time. It seemed that application of these devices in dual hip and proximal shaft fractures, which are devoid of physiological bowing of the shaft, would get the best results. But when they are applied to dual fractures of the hip and the middle portion of the shaft, certain techniques, like adequate distal fixation, the prebending of the plate, primary bone graft and mobilization of the non-weight bearing pattern should be strictly adhered to for assurance of early callus formation and prevention of implant failure.

Adult↗