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A modified transgluteal approach to the hip joint without osteotomy of the trochanter is described. The advantage of this approach is a better view of the acetabular rim, prevention of gluteal muscle damage and protection of the superior gluteal nerve.
We present a case of a paravertebral abscess with extension into the hip joint. The presumed conduit of infection in this case is the iliopsoas bursa, which has been shown to provide direct communication between the retroperitoneal space and the hip joint in up to 15% of cadaveric specimens. The patient was treated with emergent open irrigation and debridement of the hip joint, as well as percutaneous drainage of the prevertebral abscess. The patient remains minimally symptomatic at the 2-year follow-up.
The pattern of distribution of cartilage thickness in corresponding femoral heads and acetabula was ascertained in ten hip joints. The differences between individual acetabula and their corresponding heads were small enough for it to be admissible to calculate an average distribution pattern for head and socket. Comparison of these patterns showed that: (a) The maximum thickness is found at points in the ventrocranial area of the acetabulum and ventrolateral area of the head. (b) From these points the cartilage thickness decreases concentrically. (c) In the 'natural position' of the hip joint the points of maximum thickness of head and acetabular cartilage do not correspond. In relation to the line of the hip joint 'force resultant', the area with the thickest cartilage on the head is slightly shifted towards its medial side, and on the socket slightly to the lateral side. It is not possible fully to explain these results on the basis of existing conceptions about the functional stressing of the hip joint.
BACKGROUND: Various qualitative and quantitative radiological geometrical parameters can be of great help when assessing dysplasia of the hip joint and in understanding developmental processes of the infant hip. There are few data on the normal values of the hip joint at different ages. OBJECTIVE: To perform radiographic measurements on hip joints considered to be anatomically normal and to provide data for each age group, thus describing features of the radiographic development of the hip. MATERIALS AND METHODS: Radiographs were examined from 355 children (age 0-16 years) undergoing examination for scoliosis (long film), urography or plain abdominal radiography. Qualitative and quantitative signs were observed and measured, focusing on the Hilgenreiner, Wiberg and Idelberger angles and the decentric distance. RESULTS: Before the age of 9 years measurable data from neighbouring age groups differed significantly, indicating typical radiological changes of the joint. For the same age range, qualitative changes could also be observed. After 9 years of age, radiological development of the normal hip joint during childhood is much slower.
There is currently renewed interest in articular resurfacing for the treatment of damaged hip-joint cartilage. In contrast to these implants, which involve endoprosthetic replacement of both articulating surfaces, we present a new joint-preserving technique that allows treatment of local osteochondral defects of the femoral head by partial hemi-resurfacing. In this study we describe the operative and technical aspects and problems for partial hemi-resurfacing of the hip joint and critically discuss indications for this procedure in one case. To guarantee an adequate view of the situs, we recommend a surgical approach involving trochanter flip osteotomy, followed by surgical dislocation of the hip joint. Besides partial hemi-resurfacing of the osteochondral defect, this approach allows treatment of associated labral tears and cartilage defects of the hip joint at the same time. For adequate implant fixation, good bone quality is required. Furthermore, osteochondral defects of limited extent and excellent patient compliance are essential for clinical success. In particular, prominence of the implant has to be avoided, which can lead to an irregular joint surface and may induce further cartilage destruction. Long-term studies on statistical populations will show if partial articular hemi-resurfacing is a bone-preserving and useful therapeutic alternative to hemi-resurfacing caps in the treatment of osteochondral hip-joint defects, especially in young patients.
We investigated the strain on the transverse acetabular ligament (TAL) and the labrum close to the anterior and posterior horn of the lunate surface using Omega strain gauges [5] while increasing loads were applied to the hip joint. Two fresh hip joint specimens and four specimens fixed in 3.7% formalin were examined. The two components of the joint were disarticulated and soaked in physiological saline and then placed in a material-testing machine (Zwick) in the neutral position of the joint. The strain on the TAL and the labrum was measured at loads of 10 N, 350 N, 700 N, 1050 N, 1400 N, 2100 N and 2800 N. Finally, the contact areas were measured at a load of 350 N using a polyether casting method. Depending on load, the length of the TAL increased by up to about 3.2% at a load of 2800 N, but the length of the labrum increased by only 0.5% at the same load. Following rotation of the femoral head to positions corresponding to 15 degrees extension and 15 degrees and 30 degrees flexion, only slight differences of about 0.2% for the TAL and even less for the labrum were measured. The contact areas are all located in the anterior and posterior horn of the lunate surface. The measured changes in strain on the TAL confirm the widening of the acetabular notch and a subsequent stretching of the TAL as the load on the hip joint increases.(ABSTRACT TRUNCATED AT 250 WORDS)
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.
The authors present their first experience with sonographic examination of children's hip joints. Between May 1988 and the end of 1989 they examined in total 4000 children's hip joints. They made a group of patients comprising 1500 hip joints in 750 children. The examination was performed by a portable sonographic 5 MHz probe. In the given group there occurred the decrease of the number of pathological x-ray findings in the 3rd month to 6.6 per cent as compared to 14.1 per cent in the control group. The authors explain this decrease by a timely treatment also of clinically negative findings in case of the pathological sonographic finding in the maternity hospital.
INTRODUCTION: Intra-acetabular localisation of an osteochondroma causing subluxation of the hip joint is a rare entity in children suffering from multiple hereditary exostoses. In literature only 6 operatively treated cases have been reported. CASE: We add the case of an 8-year-old boy with an intraarticular exostosis of the left acetabulum causing subluxation of the hip. Using an anterolateral approach to the hip joint this exostosis was removed surgically together with some extraarticular exostoses of the proximal femur. The hip could be re-centered in combination with an additional varus derotation osteotomy of the proximal femur. Intraoperatively the femoral head was only subluxated to minimise the risk of avascular necrosis. After a follow-up of two years the patient has complete remission of symptoms and there is no evidence of avascular necrosis radiologically with good remodelling of the left hip. CONCLUSION: The operative treatment of an intraarticular exostosis of the hip joint is a difficult and risky surgical procedure. The reported open surgical procedure allowed resection of the intraarticular exostosis in combination with therapy of additional pathologies of the proximal femur.
BACKGROUND: A real congenital dislocation of the hip joint is very rare. Because of the severeness of the disease an immediate diagnosis and begin of treatment is required. PATIENTS: Between 1984 and 1995 clinical and sonographic screening examinations at 4177 newborns were performed at our hospital. METHODS: We analyzed our patients retrospectively and found out all cases of congenital dislocation of the hip joint. All these cases were classified and the results of treatment were determined. The clinical success of our strategy of treatment was described. RESULTS: Among the 4177 observed newborns 39 cases of congenital dislocation of the hip joint in 27 children were found. We diagnosed the hip type IIIa, IIIb and IV according to Graf in 28.2 and 9 cases respectively. After 12 month a complete healing rate of 95 percent was exhibited with the functional management strategy. Five percent of the affected joints showed a residual dysplasia. The rate of residual dysplasias was 2.5%. CONCLUSIONS: The good prognosis after our early treatment strategy severe congenital dislocation of the hip joint underlines the use of earliest therapy together with a hip screening program.
At the Orthopaedic Clinic of the Institute for Postgraduate Medical Training in the course of 10 years (1979-1989) 2340 primary implantations of total endoprostheses of the hip joint were performed. During the same period 168 total endoprostheses of the hip joint and 20 cervico-occipital prostheses were reoperated. The most frequent reason for reoperation was aseptic loosening of the acetabular component. The mean period between operation and reoperation in these patients was 98 months. In the group with loosening of the socket associated with mechanical destruction of the component the mean period which had elapsed since the primary operation was 43 months. In 87% small size sockets were involved. The most serious problem of reoperation of total endoprostheses of the hip joint is replacement of bone defects. During reoperation of acetabular components an isolated defect on the floor of the acetabulum was found in 26%, a defect of the margins in 38% and a combined defect of the margins in 26% of the patients. For treatment of the defects the authors used bone grafts in the majority allogenic grafts were involved which were used to reconstruct the margins and floor of the acetabulum. Metal implants should hold the bone grafts in the desired position and should not serve as a skeleton. Reoperation of the acetabular part of total endoprostheses of the hip joint is easier from the technical aspect; in defects of the upper portion of the femur it is essential to use a very careful procedure and to preserve the skeleton to a maximal extent.(ABSTRACT TRUNCATED AT 250 WORDS)
In order to design cementless femoral prostheses for the femoral canal of Japanese patients with secondary osteoarthritis of the hip joint, we analyzed the anatomical features of the hip joint in 85 hips of 55 patients with osteoarthritic hip and 90 hips of 60 subjects with normal hip in three-dimensional CT images. We found that 9 different stem designs varying in width and proximal radius were required to accommodate the hips with secondary osteoarthritis. In normal hips, the anatomical features of the proximal femoral canal to the femoral length was directly proportional. Thus, the values for the proximal radius, the position of the isthmus, off-set value and width of the stem for femoral neck fracture and aseptic necrosis of the femoral head should increase with the stem size, but the ratios of the increase were found different. The mean taper angle from the lower end to the lesser trochanter to the upper end of the isthmus was 3.8 degrees regardless of femoral length.
OBJECTIVE: To evaluate a method for experimental induction of osteoarthritis in the hip joints of dogs. ANIMALS: 12 mixed-breed dogs. PROCEDURE: A unilateral triple pelvic osteotomy was performed. In 6 dogs, the iliac osteotomy was repaired with 45 degrees of internal rotation, reducing coverage of the femoral head by the acetabulum. In the other 6 dogs, the fragments were repaired in anatomic alignment. Radiography, force plate evaluations, and subjective lameness evaluations were performed before and after surgery. Dogs were euthanatized 7 months after surgery, and samples of cartilage and joint capsule were examined histologically. RESULTS: Subjective lameness scores, radiographic appearance of the hip joints, and Norberg angles were not significantly different between groups; however, force plate evaluations did reveal significant differences in vertical ground reaction forces. Femoral head coverage was significantly decreased with rotation of the acetabulum. Mild inflammatory changes were discernible in the joint capsule and articular cartilage of some dogs in both groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that 45 degrees internal rotation of the acetabulum does not consistently induce biologically important osteoarthritic changes in the hip joints of dogs.
PURPOSE: It was the purpose of this study to investigate loading of the hip joint during various skiing activities and to compare the results with walking and running. The results are relevant to determine which skiing activities can be recommended for patients after total hip replacement. METHODS: Nine male subjects were instrumented with a 12-channel accelerometer system mounted on the upper body. Data were collected during walking, running, and six skiing activities and used as input for an inverse dynamic analysis that resulted in the time histories of the intersegmental force and moment at the supporting hip joint. Joint contact force was computed using a simple muscle model. Peak values were determined, averaged over all loading cycles, and compared between activities. RESULTS: Intersegmental force, indicating the influence of upper body weight and accelerations, was highest during running. Intersegmental moments were highest during the alpine skiing activities and indicated large extensor muscle forces at the hip joint. The peak joint contact force during walking at 1.5 m x s(-1) was 2.5+/-0.3 times body weight (BW). Running at 3.5 m x s(-1) produced a joint contact force of 5.2+/-0.4 BW during the push-off phase. Joint contact forces during four different alpine skiing conditions ranged from 4.1+/-0.6 BW (long turns, flat slope) to 7.8+/-1.5 BW (short turns, steep slope). Cross-country skiing had lower hip joint loading than running but higher than walking: 4.0+/-1.1 BW for classical technique and 4.6+/-0.6 BW for skating technique. CONCLUSIONS: Assuming that walking is a "safe" activity for a hip prosthetic patient, controlled alpine skiing and cross-country skiing appear relatively safe with respect to the magnitude of loading. However, the skiing activities showed considerably higher mediolateral and anterior-posterior forces than walking. Mechanical testing of prosthetic devices with loading conditions specific to these activities is needed to assess the effect of these force components on hip prostheses and to allow interpretation with respect to potential effects of skiing for a hip prosthetic patient.
From a sequence of planar CT-pictures of the hip joint the diagnostically relevant contours are extracted on a graphic monitor by means of an image analysis process. To enable this an image-preprocessing has been needed to improve quality of the CT-pictures. From theses contour data, a mathematical surface model of the hip joint will be derived with well-known methods to simulate osteotomy.
Although etiology and pathogenesis of congenital dislocation of the hip (CDH) is of broad interest in orthopaedics, basic questions still remain obscure. Advances in high-resolution ultrasound technology now permit investigation of the fetal hip joint in vivo. Standard values of intrauterine hip development have been established by investigating 146 fetuses (141 pregnancies) in vivo by ultrasound. Standard values describe the development from 20th weeks of gestation until birth. Prenatal Alpha- values suggest influence of intrauterine posture and spatial fetal conditions on hip development. Alpha-angles of 59.7 (SD 8.9) are achieved at the end of pregnancy. These angles meet standards of Graf's calculations for the postnatal hip development. Standard values of intrauterine hip development are of basic interest for interpretation of hip joints in premature children.
OBJECTIVE: To evaluate in vivo repeatability of the distraction index method of evaluating hip joint laxity in dogs. ANIMALS: 31 two-year-old Labrador Retrievers. PROCEDURE: Each dog was anesthetized and radiographically evaluated for hip joint laxity 4 times: twice by an experienced examiner and twice by an examiner who had no previous knowledge of or training in the technique prior to the first day of testing. Distraction indices (DI) were determined from the radiographs and intraclass correlation coefficients were calculated to evaluate the repeatability of DI measurements between and within examiners. RESULTS: Intraclass correlation coefficients were high (range, 0.85 to 0.94). Lower limits of the 95% confidence intervals for the intraclass correlation coefficients ranged from 0.75 to 0.89. CONCLUSIONS: Between- and within-examiner repeatabilities of DI measurements were high, suggesting that the technique is clinically reliable. CLINICAL RELEVANCE: Distraction index is a reliable measure of hip joint laxity and a good predictor of the risk of development of degenerative joint disease associated with hip dysplasia in dogs. Establishment of high repeatability of DI measurements suggests that the stress-radiographic method may be used by multiple examiners with the expectation of comparable and consistent results.
The extensive work on early diagnosis and treatment of CDH (in the broad sense of this term) in Sweden has formed the basis of our present organization of prevention of hip dislocation. Practically all children are born in hospital, at present about 93,000 per year (1980). Routine examination of the hip joints has been included in the check-ups of newborns since the beginning of the 1950's. The centralization of obstetrics, especially during the last decade, has facilitated the organization of these examinations by paediatric consultants in all obstetric departments. All cases of hip joint instability are recorded, and during the last few years the frequency has been about 12 per thousand, probably with some over-diagnosis due to registration of uncertain cases. All definite cases of hip instability have been treated immediately at the orthopaedic departments. A study of a series of untreated newborns with transient instability has shown that the majority, but not all, will develop normal hip joints without treatment. This has been one reason for the recommendation to treat all unequivocal cases of hip instability. The present organization of examination and treatment is described. Detailed and practical instructions for the examination and treatment are given. Follow-ups of children treated for hip instability in the neonatal period are reported. It has been found that in practically all these patients anatomically normal hip joints are achieved by means of correct and carefully followed up treatment. The findings in 65 patients with neonatal hip instability in whom the treatment was unsuccessful or inadequate have underlined the importance of a strict treatment schedule, experienced doctors and detailed information to the parents. The effect of diagnosis and treatment of hip instability neonatally on the frequency of late-diagnosed cases of CDH was studied by recording all late-diagnosed cases at all orthopaedic departments. It was clear from the latter study that instability of the hip in newborns represents "preluxation" and that the treatment of this can prevent later dislocation. Dislocation of the hip joint in newborn infants is very unusual. Nowadays it is rare even after the neonatal period--in recent years only 12% of the late-diagnosed CDH cases between 1 and 6 months of age at diagnosis. However, the total number of late-diagnosed cases in the whole country has not decreased by more than 50% compared with the period prior to the introduction of hip examination of newborns.(ABSTRACT TRUNCATED AT 400 WORDS)