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At least 307 records · Page 17Linked to original sources
PubMed1994

[A new technique of osteotomy for femoral varisation in the management of hip dislocation and paralytic subluxation of the hip].

PURPOSE OF THE STUDY: Severe valgus deformity of the upper femur is a frequent feature of the unstable paralytic hip. Thus, the insertion of the osteosynthesis material during a varization osteotomy can be technical demanding. Risks and benefits of a modified femoral varization osteotomy were evaluated in a retrospective follow-up study. MATERIAL: 53 paralytic hips (33 patients) have been operated from September 1989 to april 1993. Mean age at surgery was 6 years. The etiologies were Spinal Amyotrophy in 12 hips, Cerebral Palsy in 31 hips and miscellaneous neurologic diseases in 10 hips. The average neck-shaft angle before surgery was 162 degrees. The mean Reimers' Index was 58 per cent. METHODS: The upper femoral shaft was exposed by subperiosteal dissection in a circumferential manner. An intertrochanteric osteotomy was carried out. The direction of the femoral neck was identified. An AO 100 degree blade plate was then introduced under direct visual control through the cancellous osteotomy surface of the proximal fragment. Radiological and clinical outcome were assessed at last follow-up. Mean follow-up was 16 months. RESULTS: Solid fusion was obtained in all patients. The mean postoperative neck-shaft angle was 104 degrees. The mean Reimers' Index was 17 per cent at last follow-up. Two infections were noted. Voluminous calcifications under the femoral neck have been observed in 6 cases. Recurrence of the valgus deformity was noted in 9 hips at last follow-up. DISCUSSION: This simplified varization technique permits a large amount of varization. The medialization diminishes the problem of protruding hardware. The complications rate appears to be low without any femoral head necrosis in this series despite subperiosteal dissection of the femoral neck. CONCLUSION: The authors think that this modified varization technique may deserve consideration in the treatment of the unstable paralytic hip.

Adolescent↗
PubMed1998

Clinical evaluation of the Alta hip bolt in peritrochanteric hip fractures.

We reviewed the clinical and radiographic results of 58 patients with peritrochanteric fractures treated with the Alta hip bolt (a sliding compression device that inserts a dome plunger in the femoral head instead of a hip screw). This group was compared with a group of 53 patients treated with conventional hip screws. Three patients (5.2%) treated with the Alta hip bolt and three patients (5.7%) treated with conventional hip screw had failure of fixation. Failure of fixation consistently occurred in patients with unstable fracture patterns or significant osteopenia. There were no cases of bolt cut-out in stable intertrochanteric fractures. We conclude that the Alta hip bolt performs as well as sliding hip screws in peritrochanteric fractures, but the additional learning curve and increased cost do not justify its routine use at this point in time.

Aged↗
PubMed2005

The influence of heterotopic ossification on functional status of hip joint following total hip arthroplasty.

PURPOSE: The functional failure induced by heterotopic ossification (HO) following total hip arthroplasty (THA) was analyzed and correlated to the radiologic failure. PATIENTS AND METHODS: From July 1997 to July 2001, 315 patients (345 hips) received THA indicated by a hypertrophic osteoarthritis of higher degree (Kellgren grade III, IV). All patients were irradiated prophylactically for prevention of HO on the evening before surgery with a 7-Gy single fraction. The patients' median age was 66.3 years. Radiologic failure was assessed by comparison of pre- and postoperative hip X-rays (immediately and 6 months after surgery). Analysis of radiographs was performed according to the Brooker Score. Clinical failure was appraised by measurement of passive range of motion (ROM) of the hip joint with a standard goniometer. The t-test was used for statistical analysis. RESULTS: 281 patients (81.5%) did not develop HO. HO of Brooker grade I or II was found in 58 patients (16.8%). Six patients (1.7%) developed HO Brooker grade III or IV. There was a significant negative correlation between the degree of radiologic and clinical failure. ROM differed significantly between patients with HO Brooker grade 0, I, II and patients with HO Brooker grade III, IV. Comparing the pre- and postoperative ROM, all patients with Brooker grade 0, I and II showed a significant improvement of flexion, internal and external rotation, abduction and adduction movement. Patients with HO Brooker grade III and IV showed no improvement of ROM in the postoperative follow-up. CONCLUSION: The development of HO following THA influences the physical function of the hip joint dependent on the degree of ossification. HO of lower degree (Brooker I, II) does not influence the clinical outcome, whereas HO of higher degree (Brooker III, IV) reduces the function of hip arthroplasty. Therefore, the purpose of a prophylactic therapy must be to reduce HO of higher degree.

Aged↗
PubMed2000

Bone grafting in cementless total hip replacement for congenital dysplasia of the hip.

We reviewed 27 cementless primary total hip replacements in patients with osteoarthrosis secondary to congenital dysplasia of the hip. Autogenous bone grafting was used as augmentation. On average the follow-up period was 9 years. Two hips were revised and three acetabular components were considered loose. In hips with loose cups the average graft coverage was significantly greater than in stable hips. The use of a cementless acetabular component is encouraging for reconstruction, although extensive grafting should be avoided. Our study suggests that cementless reconstruction in dysplastic hips yields a satisfactory outcome.

Adult↗
PubMed2026

Sex-specific biomarkers predict bone mineral density loss at the contralateral hip after hip fracture.

OBJECTIVE: To identify inflammatory and hormonal biomarkers that predict bone loss at the contralateral (non-fractured) hip following hip fracture in males and females. METHODS: White participants who were not receiving pre-fracture glucocorticoids, sex-hormone therapy, or bone-active medications (100 males, 76 females) with hip fractures. Data were collected within 22 days of hip fracture and at 2, 6, and 12 months follow-up. Biomarkers were categorized into tertiles: estradiol, 25-hydroxyvitamin D3/D2, intact parathyroid hormone (iPTH), interleukin-1 receptor antagonist (IL-1RA), interleukin-6 (IL-6), insulin-like growth factor-1 (IGF-1), soluble tumor necrosis factor-α receptor 1, sex hormone-binding globulin, and testosterone. Femoral neck bone mineral density (BMD) at the contralateral hip was assessed, and losses exceeding the mean decline were classified as greater than average. Logistic regression models, stratified by sex, were adjusted for confounders and evaluated selected biomarker associations. RESULTS: Among males, the 2nd (OR = 4.79, P = 0.012) and 3rd (OR = 6.36, P = 0.005) IGF-1 tertiles were associated with greater odds of BMD loss than the 1st tertile. The 3rd iPTH tertile (OR = 3.79, P = 0.037) was similarly associated with increased odds. Among females, the 3rd (OR = 0.20, P = 0.031) IL-1RA tertile was associated with lower odds of BMD loss compared to the 1st tertile, while the 2nd IL-6 tertile (OR = 5.99, P = 0.036) was associated with higher odds. CONCLUSION: These findings suggest that inflammatory and hormonal biomarkers may be sex-specific predictors of accelerated BMD loss following hip fracture.

Biomarkers↗
PubMed1988

Clinical experience with a triradiate exposure of the hip for difficult total hip arthroplasty.

A triradiate exposure of the hip was developed to facilitate the performance of certain difficult primary and revision total hip arthroplasties. Using this triradiate skin and fascial incision, complete anterior and posterior exposure of the hip capsule can be performed with relative ease. Between October 1980 and January 1985, this exposure was used 50 times in selected cases, including 9 of 320 (3%) primary total hip arthroplasties. All of these cases involved obesity, acetabular protrusion, and/or fragile femoral bone, conditions that would have made safe, adequate exposure without trochanteric osteotomy considerably more difficult through a routine anterolateral or posterior approach. Over this period, the majority of revision hip arthroplasties were performed using triradiate exposure; trochanteric osteotomy was routinely performed in these revision cases. Excellent wound healing was observed in every case, despite unfavorable factors such as advanced age, prednisone therapy, and the presence of prior incisional scars. The triradiate incision offers safe, controlled, and improved exposure in selected primary and revision total hip arthroplasties. It has become nearly the routine incision for the senior author for revision cases.

Aged↗
PubMedDate not supplied

[Reimplantation of the artificial hip joint in girdlestone hips is superior to girdlestone arthroplasty by itself].

AIM: The aim of this work was to compare the functional results of secondary Girdlestone hips with the results of total hip replacement (THR) after a Girdlestone situation. METHODS: 72 patients with THR following a Girdlestone situation and 87 patients with a Girdlestone situation (90 hips) were compared with regard to defined endpoints. RESULTS: THR following a Girdlestone situation provided for significantly higher patient satisfaction (89 % versus 13 %) and hip function (HHS 63 versus 39 points). The groups only marginally differed with regard to the incidence of complications (0.32 versus 0.26 per patient) and the necessity for surgical revision (0.38 versus 0.31 per patient). CONCLUSION: Conversion of Girdlestone hips with THR provided patient satisfaction and functional results superior to secondary Girdlestone hips while the incidence of postoperative complications and revisions were similar for both groups. These differences justify attempts at the conversion of Girdlestone situations with THR, if technically possible, in accordance with the patient's wish and as allowed by his/her general health.

Adult↗
PubMedDate not supplied

[Total hip arthroplasty in congenital dysplasia of the hip: follow-up of a small-dimensioned, cemented straight stem].

AIM: The aim of this study is to report the survival and mid-term results including patient-relevant outcome measures with a small-sized cemented stem (CDH-stem) for the treatment of coxarthrosis secondary to developmental dysplasia of the hip. METHOD: 33 total hip replacements were performed with the CDH stem, 29 of which (88 %) were included in the follow-up after an average of 7.6 years. According to the classification system of Hartofilakidis et al., 10 hips were classified as type 1, 15 as type 2, and 3 as type 3. Survival was predicted using Kaplan-Meier survivorship analysis with revision as the end point. Results were assessed using the Harris hip score, as well as the WOMAC and SF-36 as patient-relevant outcome measures. RESULTS: Survival at thirteen years was predicted to be 92.4 % for the stem and 87.6 % for the varying acetabular implants used. At the time of the final follow-up, the average Harris hip score was 82.45 points. The global WOMAC index averaged 2.1, the average SF-36 score was 66.2 points. CONCLUSIONS: The data support the use of a small-sized cemented stem in small femora for total replacement of the dysplastic hip. To the best of our knowledge, this is the first study utilising the well validated WOMAC and SF-36 as patient-relevant outcome measures in this subgroup of patients.

Aged↗
PubMed1994

An electromyographic analysis of the hip abductors during load carriage: implications for hip joint protection.

Decreasing the relative force demands on the hip abductor muscles may reduce hip joint forces. The purpose of this study was to use surface electromyography (EMG) to determine the relative demand on the hip abductor muscles as subjects walked and carried single hand-held loads of multiple weights. Thirty healthy, college-aged subjects carried single hand-held loads by their side. The loads weighed between 3 and 30% of body weight. Loads were carried in a position either ipsilateral or contralateral to a given hip side. Normalized EMG (%EMG) was collected during the middle stance phase of walking. The amount of %EMG remained statistically equal to or less than the no-load EMG baseline for all ipsilateral-held loads and greater than the no-load EMG for all contralateral-held loads above 3% body weight. Load positions and weights that generated %EMG levels less than or equal to the no-load baseline most likely offer a degree of hip joint protection for persons with hip disability.

Adult↗
PubMed2001

Total hip replacement for the dislocated hip.

Replacing the dislocated hip is technically more challenging than replacing the subluxated hip. Overall, clinical and radiographic results have not been as good for hips that are completely dislocated. The surgical approach must allow for identification of the false and true acetabula, identification of the sciatic nerve, and lengthening of the leg. In patients with a dislocated hip who are managed with total hip replacement, coverage of the cup can be achieved by medialization, creation of a high hip center, or use of a structural graft. Bone grafting allows the cup to be placed in an anatomic position, provides bone stock for additional surgery, and restores leg length. Our results and the results of other authors confirm that these grafts remain intact for at least 10 years and restore bone stock for additional surgery. This is particularly important in this relatively young population.

Acetabulum↗
PubMed1998

Results of total hip arthroplasty for Crowe Type III developmental hip dysplasia.

From 1969 through 1980, 90 hips in 82 patients had cemented total hip arthroplasty for Type III developmental hip dysplasia. Seventy hips were reviewed at an average of 16.6 years (range, 5-23 years) after operation. Aseptic loosening developed in 53% of acetabular cups and 40% of femoral stems. Despite attempts to place acetabular components in the anatomic center, 18 cups (25.7%) were placed outside that area. Using a measurement method to determine the true acetabular region and approximate femoral head center, final acetabular loosening strongly correlated with initial cup placement. Loosening occurred in 15 of 18 cups (83.3%) initially positioned outside of the true acetabular region compared with loosening in 22 of 52 cups (42.3%) initially positioned within the true acetabular region. Acetabular loosening also correlated with initial lateral displacement or initial superior displacement of the hip center from the approximate femoral head center. Initial cup placement medial to the approximate femoral head center was predictive of successful long term acetabular component fixation. The method of acetabular reconstruction did not affect eventual cup loosening. Placement of the hip arthroplasty center of rotation in or near the true acetabular region is recommended.

Acetabulum↗
PubMedDate not supplied

[The hip head-conserving management of traumatic medial cervical hip fractures with big-fragment screws: a biomechanical examination].

AIM: With the growing number of elderly people in the population and the increasing incidence of proximal hip fractures the question of how to manage the medial hip head fracture is of increasing importance. Especially in Hungary and the Scandinavian countries surgeons prefer hip head-conserving therapy although the redislocation of this fracture and necrosis of the hip head opposes this point of view. METHOD: Encouraged by two theoretical and mathematical calculations, we tested two different possibilities to screw hip head fractures. RESULTS: Our results show that the hip head-conserving therapy with two cranial screws and a three-point-supported screw at Adam's arc has essential biomechanical advantages compared with the situation after conventional osteosynthesis. CONCLUSION: This result encourages us to prefer the minimally invasive head-conserving therapy of medial hip head fractures, especially for treatment of Pauwell's I and II injuries.

Adult↗
PubMed2000

Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures.

BACKGROUND: Hip fracture patients have a high risk of thromboembolic complications following surgical management. OBJECTIVES: To examine the effects of heparin (unfractionated (U), and low molecular weight (LMW) heparins), and physical methods (compression stockings, calf or foot pumps) for prevention of deep venous thrombosis (DVT) and pulmonary embolism after surgery for hip fracture in the elderly. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline, Embase, and reference lists of published papers and books. We contacted trialists and other workers in the field. Date of most recent search: September 1996. SELECTION CRITERIA: Randomised and quasi-randomised trials evaluating the use of heparins and physical agents for prevention of DVT and pulmonary embolism in patients undergoing surgery for hip fracture. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed methodological quality and extracted data. Trials were grouped into four categories (heparin versus control, mechanical versus control, LMW heparin versus U heparin, and miscellaneous) and results pooled where possible. MAIN RESULTS: The 26 included trials involved 2600 predominantly female and elderly patients. Overall, trial quality was disappointing. Ten trials involving 826 patients which compared U heparin with control, and four trials of 471 patients which compared LMW heparin with control, showed a reduction in the incidence of lower limb DVT (121/511 (24%) versus 203/519 (39%); Peto odds ratio 0.41; 95% confidence interval 0.31 to 0.55). There were insufficient data to confirm the efficacy of either agent in the prevention of pulmonary embolism. There was a non significant increase in overall mortality in the heparin group (46/420 (11%) versus 35/423 (8%); Peto odds ratio 1.39; 95% confidence interval 0. 86 to 2.23). Data were inadequate for all other outcomes including wound complications. There is insufficient evidence from five trials, involving 644 patients, to establish if LMW heparin was superior to U heparin. Most trials evaluating heparins had methodological defects. Four trials, involving 442 patients, testing mechanical pumping devices were also methodologically flawed, and so pooled results need to be viewed cautiously. Mechanical pumping devices may protect against DVT (12/202 (6%) versus 42/212 (19%); Peto odds ratio 0.24; 95% confidence interval 0.13 to 0.44). Although the limited data indicated a potential benefit, they were inadequate to establish any effect on the incidence of pulmonary embolism and overall mortality. Problems with skin abrasion and compliance were reported. REVIEWER'S CONCLUSIONS: U and LMW heparins protect against lower limb DVT. There is insufficient evidence to confirm either protection against pulmonary embolism or overall benefit, or to distinguish between various applications of heparin. Foot and calf pumping devices appear to prevent DVT, may protect against pulmonary embolism, and reduce mortality, but compliance remains a problem. Good quality trials of mechanical methods as well as direct comparisons with heparin should be considered.

Anticoagulants↗
PubMed2000

Total hip arthroplasty after arthrodesis of the hip joint.

The results of 15 conversions of a hip arthrodesis into a total hip arthroplasty performed in the years 1980-1995 are reported. Fifteen patients (8 men, 7 women) underwent total hip arthroplasty 30.9 (range 2-61) years after spontaneous or operative fusion of a hip joint. The primary indications of the conversion were low-back pain (n = 10), knee pain (n = 2) and hip problems (n = 3). At follow-up examination 5.4 (range 2-13.3) years postoperatively, the Harris Hip Score averaged 86.0 (range 70.1-99.0). Six patients were pain-free, 7 had less pain, 2 felt no improvement of pain. All patients confirmed that they would undergo the operation again. The Trendelenburg sign was negative or mild in 8 patients and moderate to severe in 7. Aseptic loosening of 2 stems (1 cemented, 1 cementless) and 2 deep infections required revision surgery. We conclude that this operation can lead to satisfactory results even after a long duration of the arthrodesis. However, full function with no pain and a negative Trendelenburg sign could be obtained in only 20% (3/15) of the cases.

Adult↗
PubMed2000

Total hip arthroplasty revision using the press-fit CLS Spotorno cementless stem. Twenty-four hips followed between 1987 and 1998.

A retrospective study of uncemented femoral revision for loosening after total hip arthroplasty was conducted for the period 1987-1998. The study included 24 hips in 22 patients (7 men, 15 women). The revision procedure consisted of the replacement of the loose hip prosthesis using the CLS (Protek) press-fit stem. Patients were followed for a mean duration of 4.5 years. The mean interval between the primary operation and the revision was 10 years (range 2-16 years). Using the Merle D'Aubigné hip score and radiographic findings, a favorable outcome was noted in 20 hips. We suggest that the femoral revision procedure using the uncemented Spotorno stem is a very useful method of correction of loosening after total hip replacement.

Adult↗
PubMed2006

Total hip arthroplasty with an uncemented hydroxyapatite-coated tapered titanium stem: results at a minimum of 10 years' follow-up in 104 hips.

BACKGROUND: The purpose of this study was to evaluate the minimum 10-year results of primary total hip arthroplasty using an uncemented, hydroxyapatite-coated tapered stem. Radiological signs of bone remodeling are also presented. METHODS: We followed a consecutive series of 105 patients (115 hips), who had had an uncemented, proximally hydroxyapatite-coated Bi-Metric femoral component for a mean of 12.2 years (range 10.0-14.9 years). The average age at operation was 52 years. Detailed clinical and radiological analyses were performed after a minimum of 5 and 10 years. Eight patients (10 hips) had died, and one patient was lost to follow-up, leaving 104 hips for final evaluation. The clinical result was evaluated by the Harris Hip Score, complications, and thigh pain. RESULTS: All patients still had their femoral components in place at the final follow-up. The average Harris Hip Score after 10 years was 92 (range 50-100) with no deterioration over time. Radiologically, several signs of progressive remodeling were identified, but no stem showed signs of loosening. CONCLUSIONS: The intermediate clinical and radiological results with this stem are encouraging. In the hands of various surgeons, the stem has performed well in a young, high-risk population.

Adult↗
PubMed2005

Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty.

We evaluated 60 limbs in 30 patients with unilateral primary total hip arthroplasty and nondiseased contralateral hip. The ratio of femoral offset (FO) to the body weight lever arm (FO ratio) and the ratio of the height of hip center (HC) to pelvic height (HC ratio) were calculated on radiographs. Isometric hip abductor strength was measured by dynamometer. The ratio of normalized strength of the reconstructed side to that of the nonoperated side was calculated (strength ratio). The FO ratio correlated positively to the strength ratio (r = 0.491; P = .0059), whereas the HC ratio correlated negatively (r = -0.568; P = .0011). Slight increase of FO ratio along with restoration of normal hip joint center erring on the side of slight inferomedial cup positioning appeared to optimize hip abductor function.

Aged↗
PubMed1995

Total hip arthroplasty for arthrodesed hips. 5- to 13-year results.

The functional outcome of total hip arthroplasty for arthrodesed hips was evaluated. During the years 1979 to 1988, 55 arthrodesed hips were converted to total hip arthroplasties. Thirty-seven women and nine men were followed for a minimum of 5 years. Thirteen of the patients were very much satisfied with the operation, 19 were much satisfied, 7 were satisfied, 3 were less satisfied, and 4 were unsatisfied. The Harris hip score was improved from 51-83 at the time of operation to 53-93 at the follow-up examination. Before conversion, none of the patients used crutches. At the follow-up examination, 10 patients used two crutches, 24 used one crutch, and 12 did not need support. Muscle strength of the abductors ranged from 1 to 4. In 26 patients with major low back pain before conversion, the pain score improved from 3-10 at the time of operation to 0-8 at the follow-up examination. This study shows that with conversion of an arthrodesed hip to arthroplasty, most patients need support for walking; however, they are generally grateful for their new mobility, maneuverability, and improved ability to sit comfortably.

Adult↗