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At least 325 records · Page 18Linked to original sources
PubMed1997

Subtrochanteric femoral shortening osteotomy in total hip arthroplasty for high-riding developmental dislocation of the hip.

A surgical technique, which uses a transverse osteotomy, for subtrochanteric femoral shortening and derotation in total hip arthroplasty for high-riding developmental dislocation of the hip is described. Anteversion is set by rotating the osteotomy fragments, and torsional stability is augmented with allograft struts and cables when indicated. Eight patients with 9 total hip arthroplasties were followed for an average of 43 months (range, 24-84 months). Good to excellent results were obtained in 87% of patients (7 of 8). Eight of 9 osteotomies (89%) demonstrated radiographic evidence of healing at an average of 5 months. One patient had an asymptomatic nonunion of the osteotomy site but still had a good overall clinical result. Another patient suffered fatigue failure of a distally ingrown porous device, which necessitated revision total hip arthroplasty 18 months after surgery. Subtrochanteric osteotomy in total hip arthroplasty for developmental dislocation of the hip allows for acetabular exposure and diaphyseal shortening while facilitating femoral derotation. Furthermore, proximal femoral bone stock is maintained and some of the potential complications of greater trochanteric osteotomy may be avoided.

Adult↗
PubMedDate not supplied

Hip arthroscopy without traction: In vivo anatomy of the peripheral hip joint cavity.

PURPOSE: To describe the in vivo anatomy of the peripheral compartment of the hip joint using a systematic sequence of examination without traction. TYPE OF STUDY: Case series. METHODS: We performed 35 hip arthroscopies without traction from an anterolateral portal in the supine position. Free draping and a good range of movement of the hip joint were used to relax parts of the capsule and increase the intra-articular volume of the area that was inspected. Each procedure was documented on a standard protocol including detailed information on technical features and normal and pathologic intra-articular findings. RESULTS: A comprehensive inspection of the peripheral compartment was obtained from the anterolateral portal. A systematic sequence of examination was developed separating the periphery of the hip joint into 7 areas: anterior neck area, medial neck area, medial head area, anterior head area, lateral head area, lateral neck area, and posterior area. The arthroscopic in vivo anatomy of each area is described. In 3 patients, 1 to 3 loose bodies were removed. In 1 patient with a synovial chondromatosis, 40 chondromas were retrieved. In osteoarthritis, impinging osteophytes were trimmed in 3 cases and partial synovectomy was performed in 10 patients. The following complications were observed: a temporary sensory deficit of the lateral femoral cutaneus nerve in 1 patient, scuffing of the anterior surface of the femoral head in 3 patients, detaching of an osteophyte in 1 patient, and partial tears of the anterior synovial fold in 10 patients. CONCLUSIONS: Arthroscopy without traction allows for a complete evaluation of hip anatomy without the loaded articular surfaces, the acetabular fossa, and the ligamentum teres. For a complete overview of both the central and peripheral part of the hip, traction is necessary for the central part.

Arthroscopy↗
PubMedDate not supplied

[Total endoprosthetic management of the hip joint after failed osteosynthesis of para-articular hip fracture].

OBJECTIVE: Treatment of fractures of the proximal femur by open reduction and internal fixation is prone to complications and frequently requiring secondary joint replacement. The aim of the present study was to examine the results of total hip arthroplasty as a salvage procedure for failed internal fixation of femoral or acetabular fractures. PATIENTS AND METHODS: We retrospectively studied 145 patients who had undergone 146 total hip arthroplasties for failed internal fixation of femoral (n = 135) or acetabular fractures (n = 11). Mean follow-up time after insertion of the hip endoprosthesis was 7.1 years (1.5-14.7 years). Patient evaluation included a history, clinical examination, and standard radiographs. RESULTS: Twenty-eight patients had died, and 18 patients were lost to follow-up. Kaplan-Meier analysis with revision of the implants as the end-point demonstrated 85 percent survival after ten years. Using the Merle d'Aubigné rating system, we found good or excellent results in 85 percent of the cases. However, only 73.9 percent of the patients were satisfied with their result, and 40.9 percent still showed a positive Trendelenburg gait at follow-up. The perioperative mortality was 2.7 percent. Surgery-related femoral fractures or fissures were observed in 18 cases, and deep infections in four. CONCLUSIONS: In comparison with data of patients who had undergone primary total hip arthroplasty for osteoarthritis in our department, the results reported here after secondary hip replacement are clearly inferior. Nonetheless, alloarthroplasty of the hip still is the most effective procedure after failed internal fixation for acetabular or proximal femoral fractures.

Adult↗
PubMedDate not supplied

[Limits in cementless hip revision total hip arthroplasty. Midterm experience with an oblong revision cup].

UNLABELLED: Revision of an acetabular component in a patient who has severe periacetabular bone loss is a complex problem, particularly when there is not enough bone stock to allow placement of an acetabular component near the normal anatomical hip center. To fill the defect, a valuable option for revision arthroplasty is the cementless oblong revision cup (LOR). METHODS: 50 consecutive revisions of the acetabular component were performed in 48 patients. The mean age at the time of revision was sixty-one years (range, thirty-three to seventy-eight years). Forty-eight hips were available for follow-up, at a mean of thirty-two months (range, eighteen to sixty-one months). The acetabular defect classified according to Paprosky, the migration and the radiolucencies were followed radiologically. RESULTS: 8 hips (16 %) were revised again: two because of infection (4 %) and six because of instability (12 %). The revised hips are not associated to the preoperative degree of acetabular defect (34 % defect type III) (P > 0.05). The mean Harris Hip score was corrected from 36.5 (range, 7.5 to 92.5) to 78.2 points (range, 47.6 to 97.6) (P < 0.01). The mean d'Aubigné Score was corrected from 8.3 (range, 4 to 6) to 15 points (range, 10 to 18) (P < 0.01). Neither pre- nor postoperative results were associated to the degree of acetabular defect (P > 0.05). However, patients with multiple revisions had a significantly reduced clinical outcome than patients with the first revision (P < 0.05). The hip center of rotation, cranially placed to the contralateral side (0.92 cm) was corrected by the revision to a more normal anatomic rotation center (0.27 cm). Partial zonal radiolucencies, always smaller than 1.5 mm were seen in 30 % of the patients. The mean migration of the acetabular component was not significant (P > 0.05). CONCLUSION: The authors support the use of the cementless oblong revision cup if contact can be made with host bone to more than 50 %. If this is not possible, acetabular bone reconstruction combined with a roof ring and a cemented cup is the component of choice.

Acetabulum↗
PubMed1995

[The magnetic resonance tomographic optimization of hip joint cartilage visualization by the selection of a T1-volume gradient-echo sequence and the use of hip-joint traction].

PURPOSE: The purpose of this study was to examine the accuracy of MR imaging of the healthy and the arthrotically altered articular hip cartilage with in vivo and in vitro separation of femoral head cartilage and acetabular cartilage. MATERIAL AND METHODS: Images of three animal cadaver hips, 8 dissected patient femoral heads and 18 hip joints of human corpses, all either with arthrosis stage I-III or artificial cartilage defects, were compared with their corresponding anatomic sections. Additional histomorphologic examinations of the arthrotic cartilages were conducted, and MR-Imaging of 20 healthy and 21 arthrotic patient hips was performed using a specific traction method. RESULTS: Using a T1-weighted 3-dimensional gradient-echo sequence and a traction of the hip joint, it was possible due to the low-signal imaging of the joint space to separate in vivo the high-signal femoral head cartilage from the high-signal acetabular cartilage. In horizontal position of the phase-encoding parameter, minimisation of the chemical-shift artifact, mainly in the ventro-lateral areas, was accomplished. MRI measurements of the articular cartilage widths showed significant correlations (p < 0.001) with the corresponding anatomic sections. At the same time the T1 3-dimensional gradient-echo sequence of the lateral femoral head with r = 0.94 showed the lowest deviations of the measurements. It was possible with MR imaging to distinguish four cartilage qualities. CONCLUSIONS: Using these MR-examinations, an improved imaging of early stage arthrotic cartilage defects is possible, and the status of the arthrotic hip cartilage with regard to intertrochanteric osteotomy can also be assessed.

Animals↗
PubMed2002

A test model of hip brace for prevention of dislocation after total hip arthroplasty (Zetton Band).

Hip dislocations remain an intractable problem in patients with soft tissue impairment, particularly in those with muscle weakness around the hip, such as those who have undergone revision total hip arthroplasty (THA). At the authors' hospital, postoperative dislocations were observed in 10 of 154 hips between January 1985 and June 1988. Five hips required re-replacement. Conventional measures to prevent or treat post-THA dislocations have been anti-dislocation pants for soft fixation and a cast or abduction-forcing braces for firm fixation. However, the anti-dislocation pants for soft fixation were not as effective as indicated by the above 10 postoperative dislocations. The firm fixation techniques are considered to cause a reduction in muscle strength, causing psychological stress and poor activity of daily living (ADL). The authors devised a soft brace for easy application and prepared its test model to prevent muscle weakening, allow stability of the hip during rotation and avoid restrictions in ADL. This brace was applied to a patient who had 3 dislocations in a short period after being discharged who sustained a postoperative dislocation and achieved good results.

Aged↗
PubMed2003

Total hip arthroplasty for the treatment of osseous ankylosed hips.

The long-term results of total hip prostheses in 86 patients (87 hips) who had either primary cemented or cementless total hip arthroplasty after fusion take-down were analyzed. Thirty-eight patients (38 hips) had a surgical fusion and 48 patients (49 hips) had a spontaneous fusion. The mean age of patients was slightly older in the cemented group (49.8 years) than in the cementless group (43.8 years). Twenty-six of 42 patients (62%) in the cemented group and 32 of 44 patients (73%) in the cementless group were younger than 50 years. Clinical (Harris hip rating system) and radiographic evaluations were done preoperatively and at 6 weeks, at 3, 6, and 12 months, and yearly thereafter. The average followup was 10.2 years (range, 8-18 years) in the cemented group and 9.8 years (range, 8-17 years) in the cementless group. The revision rates were 16% in the patients who had surgical fusion and 18% in the patients who had spontaneous fusion. The revision rates were 17% in the cemented group and 18% in the cementless group. The average linear wear rate of polyethylene per year was 0.24 mm in the cemented group and 0.32 mm in the cementless group. The incidence of osteolysis was 52% in the cemented group and was 58% in the cementless group.

Adult↗
PubMed2005

The hip trial: psychosocial consequences for mothers of using ultrasound to manage infants with developmental hip dysplasia.

BACKGROUND: The hip trial aimed to assess clinical effectiveness, economic and psychosocial costs, and benefits of ultrasound imaging (US) compared with conventional clinical assessment alone to guide the management of infants with neonatal hip instability. OBJECTIVE: To report on psychosocial consequences for mothers and the developing mother-child relationship of US, and associations between abduction splinting and maternal psychosocial distress. DESIGN: Multicentre randomised controlled trial. SETTING: Thirty three hospitals in the United Kingdom and Ireland. PARTICIPANTS, INTERVENTIONS: A total of 629 infants with neonatal hip instability randomised to US examination or clinical assessment alone before treatment decision. Questionnaires were completed by 561 (89%) mothers at 8 weeks and 494 (79%) at 1 year. MAIN OUTCOME MEASURES: Anxiety, postnatal depression, parenting stress assessed by standardised questionnaires. Maternal concerns about hip problems were assessed using the Infant hip worries inventory. RESULTS: At 8 weeks, there were no differences between US and non-US groups of the trial in maternal anxiety (mean difference (MD) -1.2, 95% confidence interval (CI) -3.2 to 0.8), depression (MD 0.0, 95% CI -0.7 to 0.8), parenting stress (MD -1.2, 95% CI -2.8 to 0.4), or other measures. The same pattern was evident at 1 year. In an explanatory analysis, early splinting was associated with increased anxiety at 8 weeks (MD 3.8, 95% CI 1.7 to 5.9) and increased level of hip worries at 8 weeks (MD 6.8, 95% CI 5.6 to 7.9) and 1 year (MD 1.3, 95% CI 0.3 to 2.4). CONCLUSIONS: Although early splinting is associated with maternal anxieties, US is not associated with any increase or reduction in psychosocial effects on mothers. Together with the clinical findings, this suggests that the use of US allows reduction in splinting rates without increased risk of adverse clinical or psychosocial outcomes.

Adult↗
PubMed1993

Epidemiological study of the relation between arthritis of the hip and hip fractures.

OBJECTIVES: To clarify the nature of the relation between hip fractures and osteoarthritis. METHODS: The study was a population based case-control study conducted in Sydney, Australia. Four hundred and sixteen men and women aged 65 years and over were recruited (209 cases, 207 controls). The presence of osteoarthritis was based on self reported pain, swelling, or stiffness of joints in the past year. RESULTS: Among 189 subjects aged 65 to 79 years, but not in older subjects, there was an inverse relation between self reported arthritis in any joint(s) and risk of hip fracture: the age and gender adjusted odds ratio was 0.52 (95% confidence interval 0.27 to 0.98). The prevalence of self reported arthritis of the hip was much lower in patients with hip fracture (4%) than in controls randomly selected from the community (13%); the age and gender adjusted odds ratio was 0.33 (95% confidence interval 0.15 to 0.74). There was also an inverse association between the number of joints reported to be affected by arthritis and risk of hip fracture. These associations were not explained by differences between cases and controls in body mass index or physical activity. CONCLUSIONS: The findings of this study support the hypothesis that there is a causal association between osteoarthritis and osteoporosis of the hip.

Aged↗
PubMed2002

Total hip arthroplasty for arthrodesed hips.

The benefits of converting an ankylosed or arthrodesed hip to total hip arthroplasty have been reported in the literature as have the technical difficulties associated with this procedure. This review, however, outlines the experience of a single surgeon (WJMB) at a single institution using uncemented prostheses. Between November 1991 and June 1996, 5 arthrodesed hips underwent uncemented total hip arthroplasty in 4 males and 1 female. Clinical and radiological follow-up review was for at least three years in all patients. In general, patients were satisfied with the outcome of their surgery with Harris Hip scores improving from an average of 62 preoperatively to an average of 72 postoperatively. The surgical outcome in these difficult cases was not as satisfactory as for routine total hip arthroplasty. Meticulous preoperative planning is required to aim toward leg length restoration and restoration of the abductor moment arm. A modular prosthesis allows versatility at surgery.

Adult↗
PubMed1983

The opposite hip in congenital dislocation of the hip.

A retrospective study of the development of the hip opposite a congenitally dislocated hip was carried out to identify at an early age those hips which would develop abnormally. Recognised radiological measurements were used showing the development of the joints with age. The development was compared with that of a control group of normal hips. Single measurements were shown to be unreliable in predicting the development of the hip. A simple hip ratio is proposed which predicts, at an early age and with a high degree of accuracy, the developmental outcome.

Adolescent↗
PubMed1993

Joint laxity and hip rotation in normal children and in those with congenital dislocation of the hip.

We measured the range of rotation in both hips of 397 normal children and in the unaffected hip of 135 children with unilateral congenital dislocation of the hip. Both groups were assessed for generalised joint laxity. Joint laxity was more common in normal children with an internally centred arc of hip rotation than in normal children with a neutral or an externally rotated arc. The children with congenitally dislocated hips had significantly more joint laxity than did the control group and significantly more of them had an internally centred arc of hip rotation. We suggest that the lax joint capsule fails to mould away the neonatal anteversion of the femoral neck during the first few months of life.

Adolescent↗
PubMed2005

Iliofemoral distraction and hip reconstruction for the sequelae of a septic dislocated hip with chronic femoral osteomyelitis.

We describe a technique of 'cross-hip distraction' to reduce a dislocated hip with subsequent reconstruction of the joint for septic arthritis with extensive femoral osteomyelitis. A 27-year-old woman presented with a dislocated, collapsed femoral head and chronic osteomyelitis of the femur. Examination revealed a leg-length discrepancy of 7 cm and an irritable hip. A staged technique was used with primary clearance of osteomyelitis and secondary reconstruction of the hip. A cross-hip monolateral external fixator was used to establish normal anatomy followed by an arthroplasty. A good functional outcome was achieved. The use of cross-hip distraction avoids soft-tissue and nerve damage and achieved improved abductor function before arthroplasty.

Adult↗
PubMed2006

Assessment of hip extensor and flexor strength two months after unilateral total hip arthroplasty.

This investigation assessed strength of the hip extensors and flexors when assistive devices and weight bearing are changing after total hip arthroplasty (THA). Eleven individuals (6 men, 5 women; mean age 74.45 +/- 4.88 years) with unilateral THA were evaluated isokinetically at 60 degrees x sec(-1) before surgery on the involved and uninvolved limbs. Each subject's involved limb was tested 60 days after surgery. Comparisons were made between involved and uninvolved limbs and between the involved limb before surgery and 60 days after surgery for both the hip extensors and flexors. Hip extensor and flexor strength before surgery on the involved side was 39% and 29% lower, respectively, compared with the uninvolved side. Sixty days after surgery, strength of the hip extensors and flexors improved 50% and 27%, respectively, compared with before surgery. Over the 60-day interval, the responsiveness of isokinetic testing was high for both muscle groups (range, 0.74-1.51). It would seem appropriate that intensive rehabilitation continue through at least the 60-day period and that isokinetic testing is an effective tool to monitor hip strength before and after surgery.

Aged↗
PubMed1991

Primary ceramic hip replacement: a prospective study of 119 hips.

A prospective study of 119 consecutive primary ceramic total hip arthroplasties (Autophor, Smith & Nephew) was performed. Follow up was 100% at a minimum of 3 years. Six hips were revised during the course of the study (5%). Harris hip scores were 29.0 preoperatively, 78.7 at 6 weeks, and 92.6 at 3.4 years (range: 62 to 100). Ninety-one percent of the 107 surviving hips at follow up had a good or excellent hip score. The clinical results matched those of Mittelmeier. Thigh pain was a frequent finding, but rarely presented a clinical problem. Our incidence of thigh pain may be higher than that of others because no patients were lost to follow up. The ceramic portion of the Autophor Ceramic Hip was well tolerated clinically and radiographically. The femoral component was responsible for 2% to 4% of the revisions, and we have now replaced it with a stem designed for bony stabilization.

Adolescent↗
PubMed1994

Total hip replacement in patients with osteoarthritis of the hip: improvement in pain and functional status.

A simple, self-rating questionnaire was developed to assess the clinical outcome related to pain and function after total hip replacement surgery followed by physical therapy. Twenty-two patients, 57 to 86 years of age, with osteoarthritis of the hip who underwent total hip replacement surgery and received physical therapy following surgery, participated in the study. A questionnaire consisting of 11 items was developed to ascertain the level of pain, functional ability and the assistive ambulatory device used to perform selected activities of daily living. A maximum cumulative score of 55 points was possible. The functional categories monitored included: sitting, standing, sleeping, functional walking, distance walking, stair climbing, sitting/standing from a toilet seat, driving, and sexual activities. The questionnaires were completed preoperatively, and postoperatively at 3 and 6 months. The results showed an overall improvement of 56% at 3 months and 64% at 6 months after surgery. Twenty of 22 patients obtained "excellent" results with total hip replacement surgery and follow-up physical therapy. Results of this study indicated that total hip replacement followed by physical therapy decreases joint pain and improves function in patients with osteoarthritis of the hip.

Activities of Daily Living↗
PubMed2000

[Long-term results following cemented total hip alloplasty in primary hip arthrosis. What to expect?].

The aim was to investigate the age-, gender- and implant related survival up to 14 years postsurgery in patients with primary hiparthrosis in one or both hips and operated in county hospitals with cemented prosthesis designs. The subjects consisted of 1,199 patients operated in the years 1981-1990, and the cohort was followed till 31.12.1994. The 1,199 patients had a total of 1,477 cemented total hipalloplastics (THA's) inserted. Two hundred and fourty-eight patients died during follow-up. Until 1990, 278 patients had had both hips operated, and a further 58 patients had the contralateral hip operated during follow-up to 31.12.1994. Fourty-nine hips were revised between four and 14 years (median: nine years) postsurgery. The cumulative survival for all THA's was 92.5%. Respective figures for the Richard Series 2 and the Charnley-prosthesis were 91.5% and 92%, now more than 14 years from the first operations. In conclusion, cemented total hip arthroplasty is a good treatment option for patients with primary hip arthrosis. Younger patients have an increased risk of revision, and alternative fixation may be considered. With an overall prosthesis-survival more than 14 years postsurgery of 92.5%, the treatment can take place at local orthopaedic departments. Our results are comparable to figures from the Swedish national register.

Aged↗
PubMed1992

Total hip arthroplasty in patients with avascular necrosis of the hip. Follow-up observations on cementless and cemented operations.

Thirty-one patients with avascular necrosis of the hip were treated by 34 total hip arthroplasties (THAs). All patients were observed prospectively with a minimum two-year follow-up evaluation (average, 46 months; range, 24-84 months). Twenty had cemented arthroplasties using contemporary cementing techniques. This included insertion of a medullary plug, cleansing of the canal with a medullary brush, pulsatile lavage irrigation, and insertion of the cement with a cement gun. In 14 hips, a cementless prosthesis was used. Patients were rated using a modified Harris hip score. Sequential postoperative roentgenograms were analyzed in each patient. The overall Harris hip score ratings were 88 in the cemented and 84 in the noncemented groups. Mechanical failure with loosening of the femoral component occurred in one patient who developed deep sepsis. Significant thigh pain occurred in four patients in the noncemented group. Previous studies in the literature have generally reported unfavorable results in patients with avascular necrosis of the hip treated with THA. Using cementless and cemented fixation with contemporary cementing techniques, improved results can be expected. A high incidence of thigh pain (29%) in the cementless group remains a problem.

Adult↗