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PubMed1994

[Predicting load bearing of the hip joint. Computerized analysis with a 3-D multibody model of the human].

Multibody analysis was applied to construct an advanced model of the human body, where the large joints and complete mass and inertial properties were implemented. The model represents the 50th-percentile rank of a male adult. The hip joint is controlled by three muscle forces. The muscle coordinates were taken from a data source, previously collected by our group. The model enables one to analyze 3D hip joint forces with respect to various joint angles and represents conceptually an improvement of the classical method of graphical statics, which was established by Pauwels [15]. A hip joint load of three times body weight was found in the single leg stance. A load of 3.7 times body weight was calculated when simulating a knee flexion angle of 90 degrees, and a ventral inclination of the resultant hip joint force was seen. A constant amount of gluteus medius muscle force was observed during flexion. An increasing flecting moment at the hip joint, however, had to be balanced by a significantly increased gluteus maximus muscle force. As a consequence, torsional forces can be studied by the system presented here and should also be considered when testing stems of hip prostheses. External muscle and joint forces are provided and can be used as input data for stress analyses.

Adult↗

PubMed2002

[Osteoarthritis of Hip joint--outline and diagnosis].

In osteoarthritis of hip joint, characteristic deformity occurs due to the anatomical specificity and the load of body weight. In diagnosis, it is important to recognise the status of hip joint including either primary or secondary arthritis, by careful questioning of present history and careful physical examination.

English Abstract↗

PubMed1991

New aspects of the morphology and function of the human hip joint ligaments.

The capsular ligaments of the human hip joint were submitted to exact morphological analysis, and they proved to be multiple and numerous. We have described various ligamentous systems and their interconnections, and have suggested new terminologies and systematics. The ligaments were subjected to functional analysis by means of measuring strips to determine the positions in which the ligaments are taut. The ligament systems were all found to serve a restrictive function, and various parts of the apparatus restricted all possible movements in the hip joint. Extension is restricted by the medial iliofemoral complex, abduction by the pubofemoral ligament, and adduction by the posterior coxal ligaments and by the superior ischiofemoral ligament. Flexion is restricted by the inferior ischiofemoral ligaments, inward rotation by the superior ischiofemoral ligament, and outward rotation by the lateral iliofemoral complex. Only the ligament of the femoral head is unable to exert a restricting function, despite reaching a state of tension in extreme adduction.

Femur Head↗

PubMed2001

Normal hip joint contact pressure distribution in single-leg standing--effect of gender and anatomic parameters.

A practical and easy-to-use analysis technique that can study the patient's hip joint contact force/pressure distribution would be useful to assess the effect of abnormal biomechanical conditions and anatomical deformities on joint contact stress for treatment planning purpose. This technique can also help to establish the normative database on hip joint contact pressure distribution in men and women in different age groups. Twelve anatomic parameters and seven biomechanical parameters of the hip joint in a normal population (41 females, 15 males) were calculated. The inter-parameter correlations were investigated. The pressure distribution in the hip joint was calculated using a three-dimensional discrete element analysis (DEA) technique. The 3D contact geometry of the hip joint was estimated from a 2D radiograph by assuming that the femoral head and the acetabular surface were spherical in shape. The head-trochanter ratio (HT), femoral head radius, pelvic height, the joint contact area, the normalized peak contact pressure, abductor force, and the joint contact force were significantly different between men and women. The normalized peak contact pressure was correlated both with acetabular coverage and head-trochanter ratio. Change of abductor force direction within normal variation did not affect the joint peak contact pressure. However, in simulated dysplastic conditions when the CE angle is small or negative, abductor muscle direction becomes very sensitive in joint contact pressure estimation. The models and the results presented can be used as the reference base in computer simulation for preoperative planning in pelvic or femoral osteotomy.

Adult↗

PubMed1977

Hip joint restoration in juvenile rheumatoid arthritis.

Six children with long-standing juvenile rheumatoid arthritis and radiographic evidence of severe hip joint damage were found 6 months to 5 years afterward to have radiographic evidence of significant hip joint space widening and remodeling of articular surfaces. The disease activity had decreased and hip joint function had improved in all children. Each child had received various antiinflammatory drugs, but no specific medication could be implicated in the improvement. Evidence from animal studies suggests that intensive physical therapy with emphasis on continued weight bearing may have been important in promoting healing in these children. It appears that restoration of severely damaged hip joints in JRA can occur when the disease activity is controlled. Restoration may be favored by a child's greater potential for bone remodeling and by vigorous physical therapy with emphasis upon continued ambulation.

Adolescent↗

PubMed2001

[Prevention of development of hip joint instability in patients with the spastic form of juvenile cerebral palsy].

PURPOSE OF THE STUDY: How effective are the hip adductors and flexors tenotomies for the correction of unstable hip joint in cerebral palsy? MATERIAL: The study included 45 children with contractures of the hip adductors and flexors and hip subluxations due to spastic cerebral palsy. Thirty three of them were boys and 12 were girls. Their ages ranged from 2 to 13 years. Preoperative and postoperative roentgenograms of 82 hip joints were investigated. METHODS: Open tenotomies of m. adductor longus and brevis, m. gracilis, m. rectus femoris and m. psoas major. The immobilisation by POP casts lasted for 6 weeks. Abduction and extension bracing followed the plaster removal in all children. The hip joints were radiographed in neutral rotation both before and at least 6 months after the operation. Reimers migration percentage (MP) and Wiberg angle (CE angle) known as the parameters of hip instability were assessed. The obtained data were statistically analysed. RESULTS: The preoperative MP was below 25% in 25 hips, between 25 and 39% in 33 hips, between 40 and 59% in 14, and over 59% in 10 hips. The analysis of postoperative roentgenograms showed the following MP distribution: 56 less than 25%, 23 between 25 and 39%, and 3 greater than 40%. No postoperative MP was higher than 49%. 54% formerly subluxated hips achieved normal MP. The difference between preoperative and postoperative MP was statistically significant (P < 0.001). Before the tenotomies 24 hips were normal with CE angle over 20 degrees. It was between 20 degrees and 11 degrees in 28 cases and between 10 degrees and 1 degree in 17 cases. The preoperative CE angle was negative in 13 cases. Postoperatively CE angle was higher than 20 degrees in 53 hips. It was between 20 degrees and 11 degrees in 22 cases and between 10 degrees and 1 degree in 7 cases. The minimum CE angle after soft-tissue release was 4 degrees. The difference between preoperative and postoperative CE angles was statistically significant (P < 0.001). MP improved in 93% and CE angles in 96% of cases. DISCUSSION: Classical tenotomies of the spastic hip adductors used to be recommended in prevention of the hip subluxation in cerebral palsy patients. MP improved in 70% of cases in the Reimers' study (1980) based on selective adductors tenotomies. If the soft tissue release was unsuccessful bony operation was indicated. Kalen and Black claimed in 1985 that if psoas tenotomy was performed in addition to adductors tenotomies MP improvement was attained in 80-100% of cases. CONCLUSION: Adductors and flexors tenotomies can correct the spastic hip joint instability fully and permanently if the operation is performed prior to bony changes of the hip. The operation being followed by appropriate immobilisation and physiotherapy increases the percentage of good results.

Adolescent↗

PubMed1996

Stress distribution on the hip joint articular surface during gait.

The magnitude and the direction of the resultant hip joint force are different in different body positions during gait. Therefore the stress distribution in the hip joint articular surface also changes. The aim of this work is to study how the stress distribution changes if the magnitude and the direction of the hip joint force is changed during gait. For this purpose a three-dimensional mathematical model is developed. We calculated the values of the peak stress and the location of the pole on the articular surface (where the stress is maximal) in the successive phases of the walking cycle. The values of the peak stress range from 0.8 MPa in the one limb stance phase to 2.6 MPa in the heel strike phase.

Cartilage, Articular↗

PubMed2000

A general axisymmetric contact mechanics model for layered surfaces, with particular reference to artificial hip joint replacements.

A general axisymmetric contact mechanics model for layered surfaces is considered in this study, with particular reference to artificial hip joint replacements. The indenting surface, which represents the femoral head, was modelled as an elastic solid with or without coating, while the other contacting surface, which represents the acetabular cup, was modelled as a two-layered solid. It is shown that this model is applicable to current total hip joint prostheses employing ultra-high molecular weight polyethylene (UHMWPE) acetabular cups against metallic, metallic with coating or ceramic femoral heads as well as metal-on-metal combinations. The effect of cement is also investigated for these prostheses using this model. The use of a metallic bearing surface bonded to a UHMWPE substrate for acetabular cups is particularly examined for metal-on-metal hip joint replacements. Both the contact radius and the contact pressure distribution are predicted for examples of these total hip joint replacements, under typical conditions. Application of contact mechanics to the design of artificial hip joint replacements employing various material combinations is discussed.

Biomechanical Phenomena↗

PubMed2003

A preliminary hip joint simulator study of the migration of a cemented femoral stem.

A hip joint simulator that can be used to evaluate the outcome of the cemented total hip replacement has been designed, manufactured and evaluated. The simulator produces motion of a cemented hip construct in the extension/flexion plane, with a socket to rotate internal/externally. At the same time a dynamic loading cycle is applied to the construct. A validation test was performed on a cemented femoral stem within a novel composite femur. The study demonstrates the value of using a hip joint simulator to evaluate the outcome of the cemented hip construct. A complex migration pattern of the cemented hip prosthesis with respect to load cycling was observed, demonstrated in vitro comparable prosthesis migration behaviour, both the stem migration and migration patterns, to that found clinically.

Cementation↗

PubMed1996

A computertomographic study on the congruence of the hip joint.

This study describes investigations into the appearance of intra-articular spaces of hip joints. In CT scans of cadaver hip joints in the supine position an increased intra-articular space was found dorsally, while in the prone position the same hip joint showed an increased intra-articular space ventrally. It is assumed generally that the gap between the bone ends seen on plane X-rays represents the cartilage, but this study indicates that there may in fact be a space between the cartilage surfaces in the unloaded joint.

Journal Article↗

PubMed1992

[Pericoxal fat stripes and the capsule of the hip joint. The anatomical-radiological correlations].

The capsule of the hip joint can always be demonstrated on antero-posterior radiographs provided two conditions are met: 1. the so-called gluteus minimus fat stripe is shown and 2. the exposure is made in maximal external rotation which can be either active or, better still, passive. Under these conditions the joint capsule appears as a soft tissue band stretched between the margin ot the acetabulum and the upper end of the greater trochanter. Effusions or oedemas of the hip joint cause lateral displacement of the gluteus minimus fat stripe. Anatomical and radiological comparisons, including computed tomography, confirm that the joint capsule of the hip can be demonstrated in this way.

Adipose Tissue↗

PubMed1983

[Collagen volume of the umbilical cord in infants with unstable hip joint].

Collagen amounts in the umbilical cord in infants with unstable hip joint and positive Ortolani 's sign were measured and the results were discussed from pathogenetic viewpoint. Incidence of unstable hip and that of neonatal hip with positive Ortolani 's sign were 0.23% and 0.93% respectively, in 4,824 neonates examined during one year: 1980. Biochemical analysis was carried out in the umbilical cords of 8 female neonates with positive Ortolani 's sign and of 8 female babies who were later diagnosed as having unstable hip joint. A control group consisting of 16 normal babies with similar sex, body weight, period of gestation and birth order, corresponding to the above mentioned 2 groups, was also investigated for the purpose of statistical analysis. The amount of hydroxyproline was examined by a modified Woessner 's method and the amount of collagen was calculated by Fredensborg 's method. No significant statistical difference in collagen amounts was found between these three groups. Relationship between amounts of collagen and 9 obstetrical factors relating to congenital dislocation of the hip joint: mother's height, weight and occupation; neonatal sex, birth order, position in the uterus and weight; weight of placenta and length of the umbilical cord, were studied and statistical analysis was made. Amounts of collagen in the cross section of the umbilical cord were significantly lower in neonates with longer umbilical cords.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗

PubMed1983

The effect of prophylaxis for thrombosis on heterotopic ossification following total hip joint replacement.

The effect of prophylaxis for thrombosis on heterotopic ossification was investigated using 216 total hip joint endoprostheses implanted between 1976 and 1978. During this period a random comparative study of low dose heparin and oxyphenbutazone/acetylsalycilic acid was carried out. The rate of ossification in the 216 hip joints was 17.6%, and was about average for the values specified in literature on this subject. Heterotopic ossification occurred in 30.1% of the 103 hip joints treated with heparin, whilst the rate of ossification in the 113 hip joints treated with oxyphenbutazone/acetylsalycilic acid was only 6.2%. This represents a statistically significant difference in disfavour of prophylaxis with heparin.

Aspirin↗

PubMed1999

[Surgical methods in the treatment of patients with sequelae of hip joint injuries].

The article analyzes results of treatment of 64 patients with sequelae of traumas of the hip joint. They showed that arthrodesis of the hip joint was indicated in treatment of young patients with severe posttraumatic coxarthrosis, destruction of the cotyloid cavity or the femur head including those after fighting injuries of the joint, purulent complications after traumas or preceding operations. Intertrochanteric osteotomy of the femur is reasonable in treatment of young patients with the initial stages of coxarthrosis and preserved amplitude of movement of the joint. Endoprosthesis of the hip joint is the operation of choice in patients older than 40-45 years with posttraumatic coxarthrosis and aseptic necrosis of the femur head, as well as in patients with the recurrent pain syndrome after intertrochanteric osteotomy.

Adolescent↗

PubMed1979

[The motility of hip joint endoprostheses (author's transl)].

The motility of a healthy hip joint normally seems to be better than the motility of an endoprosthesis. The movement of all models of endoprostheses must fulfill minimum requirements as well in total motility as in each way. The arithmetical investigation of the motility of commercial total endoprostheses shows good locomotion for most cases. Decisive is the relation between prosthesis head- and prosthesis neck diameter. Insufficient motility of endoprosthetic models results if especial--redundant--constructive details of the socket are selected. It seems to be more problematical to produce double cup endoprostheses which reveal sufficient function. Normally the motility of double cup prostheses must be essentially less than that of total endoprostheses or of a healthy hip joint. A special implant technique and various constructive assumptions are necessary to reach a sufficient functional result.

Biophysical Phenomena↗

PubMed2002

Changes of hip joint congruity after triple pelvic osteotomy in the dog with hip dysplasia.

Changes in hip joint congruity was evaluated in dogs with hip dysplasia before and after triple pelvic osteotomy by computed tomography examination in the standing position. Lateral center edge angle significantly increased, and center distance (CD) significantly decreased after surgery compared to the values before surgery, respectively. There was an inverse proportion between the postoperative period and the change in the ratio of CD. These results suggested that joint laxity was improved with time after surgery, providing evidence of the clinical usefulness of this surgery.

Animals↗

PubMed2003

Role of hylan G-F 20 in treatment of osteoarthritis of the hip joint.

OBJECTIVE: To study the efficacy of hylan G-F 20 in the treatment of osteoarthritis (OA) of the hip joint. DESIGN: Prospective within-group study. SETTING: Musculoskeletal rehabilitation clinic. PARTICIPANTS: Twenty-two patients (25 hips) with hip joint OA who had failed to find pain relief from conservative methods such as physical therapy, exercises, and steroid injections. Demographics included 14 men and 11 women (mean age, 56.4y), 21 of whom had mild to moderate OA and 4 of whom had severe OA of the hips. INTERVENTION: Each hip joint was injected with 2mL of hylan G-F 20 at 2, 3, and 4 weeks and fluoroscopic lavage with 100mL of normal saline at week 1. All patients had standard hip exercise regimen after the injection. MAIN OUTCOME MEASURES: American Academy of Orthopaedic Surgeons (AAOS) Lower Limb Core Scale score and visual numeric pain score. RESULTS: At 1-year follow-up, the AAOS Lower Limb Core Scale score improved from a preinjection mean of 44.2 to a follow-up mean of 86.1 (P<.05). The mean visual numeric pain score improved from a preinjection mean of 8.7 (range, 6.4-10) to a follow-up mean of 2.3 (range, 0-7.2). The overall success rate was 84%. In patients with mild to moderate OA, the mean pain score decreased from a preinjection value of 7.8 to a follow-up value of 1.7. The success rate was 90.5% in that subgroup. In patients with severe OA, the mean pain score decreased from a preinjection value of 9.1 to a follow-up value of 3.8. The success rate was 50% in that subgroup. There were no complications related to the injection. CONCLUSION: Use of hylan G-F 20 injection is a viable option for treatment of mild to moderate OA of the hip joint.

Adult↗

PubMed2001

"In vivo" determination of hip joint separation and the forces generated due to impact loading conditions.

Numerous supporting structures assist in the retention of the femoral head within the acetabulum of the normal hip joint including the capsule, labrum, and ligament of the femoral head (LHF). During total hip arthroplasty (THA), the LHF is often disrupted or degenerative and is surgically removed. In addition, a portion of the remaining supporting structures is transected or resected to facilitate surgical exposure. The present study analyzes the effects of LHF absence and surgical dissection in THA patients. Twenty subjects (5 normal hip joints, 10 nonconstrained THA, and 5 constrained THA) were evaluated using fluoroscopy while performing active hip abduction. All THA subjects were considered clinically successful. Fluoroscopic videos of the normal hips were analyzed using digitization, while those with THA were assessed using a computerized interactive model-fitting technique. The distance between the femoral head and acetabulum was measured to determine if femoral head separation occurred. Error analysis revealed measurements to be accurate within 0.75mm. No separation was observed in normal hips or those subjects implanted with constrained THA, while all 10 (100%) with unconstrained THA demonstrated femoral head separation, averaging 3.3mm (range 1.9-5.2mm). This study has shown that separation of the prosthetic femoral head from the acetabular component can occur. The normal hip joint has surrounding capsuloligamentous structures and a ligament attaching the femoral head to the acetabulum. We hypothesize that these soft tissue supports create a passive, resistant force at the hip, preventing femoral head separation. The absence of these supporting structures after THA may allow increased hip joint forces, which may play a role in premature polyethylene wear or prosthetic loosening.

Biomechanical Phenomena↗