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At least 343 records · Page 19Linked to original sources
PubMed1992

A self-administered hip-rating questionnaire for the assessment of outcome after total hip replacement.

The hip-rating questionnaire was developed for the assessment of the outcome of total hip replacement. The purpose of this study was to evaluate its reproducibility, validity, and responsiveness. The questionnaire uses a 100-point scale in which equal weight is given to the domains of global or over-all impact of arthritis, pain, walking, and function. Ninety-eight patients were enrolled in the prospective study and have been followed for at least three months; sixty-two patients have been followed for six months; and forty-two patients have been followed for one year. Reproducibility was tested with the use of the kappa statistic in fifty patients whose condition was stable clinically, and it was found to be good or excellent both for individual questions and for the total score. The validity of the questionnaire was assessed by comparison with the scores from a six-minute walking-distance test and arthritis impact-measurement scales. The result of the six-minute walking-distance test correlated with the patient's response concerning walking distance on the hip-rating questionnaire. The score for pain from the hip-rating questionnaire correlated well with the score for pain from the arthritis impact-measurement scales, and the total score from the hip-rating questionnaire correlated well with the total score from the arthritis impact-measurement scales. The score on the hip-rating questionnaire was responsive to the change in the clinical condition of the patient, as indicated by a favorable index of responsiveness. The results of the questionnaire were sensitive enough to demonstrate differences among treatment groups with relatively small sample sizes. This questionnaire has the characteristics of a useful instrument for assessment of outcomes, such as that after an operation.

Activities of Daily Living↗
PubMed1985

Clinical and roentgenographic assessment of total hip arthroplasty. A new hip score.

A new total hip scoring system is presented and applied in a group of patients who were treated by revision of total hip arthroplasty. The Mayo hip score combines clinical (80 points) and roentgenographic (20 points) data in a 100-point score. The roentgenographic input into the score decreased the percentage of good-to-excellent results because of the high frequency of roentgenographic signs of loosening. With the Harris rating, there were 63% good-to-excellent results, 12% fair results, and 26% poor results a mean of 4.25 years after component revision of total hip arthroplasty. With the Mayo system, there were 52% good-to-excellent results, 19% fair results, and 29% poor results a mean of 4.25 years after revision. A modification of the roentgenographic rating system would apply the Mayo hip score to noncemented total hip arthroplasties.

Canes↗
PubMed1984

Failed total hip replacement: assessment by plain radiographs, arthrograms, and aspiration of the hip joint.

We reviewed a series of sixty-one revised total hip replacements in order to assess the accuracy of plain radiographs (all hips), arthrograms (thirty-one hips), and aspiration (sixty hips) in demonstrating the presence of loosening or infection. Plain radiographs correctly showed the status of the fixation of 92 per cent of the femoral components but of only 63 per cent of the sockets. They indicated loosening in only 37 per cent of the loose sockets. Arthrography improved the over-all accuracy in demonstrating the status of the fixation of the sockets to 80 per cent and increased the accurate detection of loose sockets to 89 per cent; however, it was no more useful than the plain radiographs in the assessment of the femoral components. Aspiration of the joint proved reliable in excluding the possibility of infection in fifty-nine of sixty hips. We concluded that femoral components are best evaluated for loosening by plain radiographs, but arthrography substantially improves the diagnostic accuracy for loosening of the socket. Aspiration of the joint accurately excluded sepsis as the cause of pain in all of the hips from which joint fluid was obtained.

Acetabulum↗
PubMed1978

[Juvenile hip pain. 2. Femur head epiphysiolysis, hip dysplasia, tumors].

The early symptom in hip joint diseases in children is pain. Pain is localized in the groin and thight, but mostly in the knee. Other important signs are limping and reduced internal rotation. If a hip disease is suspected it is necessary to take X-rays in two planes. If diagnosis is early and special therapy started immediately, the results are usually excellent without deformation of the hip. Otherwise early osteoarthritis can develop. This is important because osteoarthritis in the hip joint is in 75% of the cases due to hip joint diseases in childhood. The problems of diagnosis and treatment of the most common hip joint diseases in children (transient synovitis, rheumatoid arthritis, osteomyelitis, Legg-Perthes disease, slipped capital femoral epiphysis, dysplasia, tumors) are discussed.

Adolescent↗
PubMed1981

Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis.

Total hip arthroplasty was done in a series of fifty-seven hips with current or prior infection. Active pyrogenic infection existed in eighteen hips at the time of arthroplasty, in five there was probable pyogenic sepsis, and in twenty-seven there was no current pyogenic infection but there was good evidence of prior pyogenic infection. Seven hips had previously been infected with tuberculosis. All but three of the eighteen patients with active infection had a revision of a previous infected arthroplasty. One had had a resection arthroplasty (Girdle-stone) followed six months later by a total hip arthroplasty. The mean length of follow-up was forty-two months. Fourteen of the eighteen reconstructions were successful. The four that were unsuccessful had recurrent infection and included the only two patients with gram-negative organisms. There was no evidence of recurrence of infection in the other three groups (thirty-nine hips).

Adult↗
PubMed1995

The influence of radiation therapy on the Harris hip score in cementless total hip arthroplasty.

Heterotopic ossification may adversely influence the outcome of total hip arthroplasty, causing discomfort or limiting the range of motion and function of the hip. In this prospective study we examined the influence of prophylactic radiation therapy on the postoperative Harris Hip Score in cementless total hip arthroplasty, with a follow-up from 2 to 5 years. Radiation therapy lowered the incidence of unsatisfactory results and increased the Harris Hip Score in hips with a poor preoperative range of motion.

Aged↗
PubMed1994

Postoperative sciatic and femoral nerve palsy with reference to leg lengthening and medialization/lateralization of the hip joint following total hip arthroplasty.

The radiographs and prospective records of 1284 (1152 primary and 135 revisions) Charnley low friction arthroplasties performed by one surgeon were studied in reference to postoperative elongation of the limb and lateralization or medialization of the center of rotation of the hip joint and their effect on postoperative nerve palsy. Displacement of the center of the hip joint in relation to fixed points on the pelvis was measured. In primary low friction arthroplasties, leg lengthening ranged from 0.4 to 4 cm; in the revision group, they ranged from 0.04 to 5.8 cm. Sixty-six hips were lengthened more than 2 cm. The center of rotation of the hip was lateralized in 18.1% of cases and medialized in 61.9%. A single case of postoperative sciatic nerve palsy (the result of laceration of the sciatic nerve at surgery) was identified. These study results indicate that nerve injuries after total hip arthroplasty may be caused by local insult, and may not be related to elongation of the limb or postoperative alteration of the center of rotation of the hip.

Adolescent↗
PubMed1993

Total hip arthroplasty in the neglected congenital dislocation of the hip. A five- to 14-year follow-up study.

A retrospective study was performed on 34 hips of 28 patients with neglected congenital dislocation of the hip after cemented total hip arthroplasty (THA) using a straight-stem prosthesis in 21 and a curve-stem prosthesis in 13 hips. The mean age at operation was 49 years (28-72 years) and the mean follow-up period was 9.4 years (5.6-14 years). Functional evaluation using Merle d'Aubigné Hip Score showed 71% success rate. Radiographic loosening occurred in three femoral and eight acetabular components attributable to poor cementing in all stems and three sockets, and to dislocation due to trauma and graft collapse in two sockets. Marked acetabular deficiency showed increased incidence of socket loosening. Both types of prostheses showed the same statistical results. Localized endosteal osteolysis appeared in five hips at the sites of less than 1-mm cement thickness. Greater trochanter nonunion reduced the functional status evidenced by pain, limping, and a statistically significant Trendelenburg sign. Proper cementing, effective acetabular reconstruction, and prevention of trochanter nonunion can produce excellent long-term results.

Adult↗
PubMed1996

A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip.

OBJECTIVE: To quantify the trade-off between the expected increased short- and long-term costs and the expected increase in quality-adjusted life expectancy (QALE) associated with total hip arthroplasty (THA) for persons with functionally significant hip osteoarthritis. DESIGN: A cost-effectiveness study was performed from the societal perspective by constructing stochastic tree, decision analytic models designed to estimate lifetime functional outcomes and costs of THA and nonoperative managements. MAIN OUTCOME MEASURES: A modified four-state American College of Rheumatology functional status classification was used to measure effectiveness. These functional classes were assigned utility values to allow the relative effectiveness of THA to be expressed in quality-adjusted life years (QALYs). Lifetime costs included costs associated with primary and potential revision surgeries and long-term care costs associated with the functionally dependent class. DATA USED IN THE COST-EFFECTIVENESS MODEL: Probability and incidence rate data were summarized from the literature. The THA hospital cost data were obtained from local teaching hospitals' cost accounting systems. Estimates of recurring medical costs for functionally significant hip osteoarthritis and for custodial care were derived from the literature. RESULTS: The THA cost-effectiveness ratio increases with age and is higher for men than for women. In the base-case scenario for 60-year-old white women who have functionally significant but not dependent hip osteoarthritis, the model predicts that THA is cost saving because of the high costs of custodial care associated with dependency due to worsening hip osteoarthritis and that the procedure increases QALE by about 6.9 years. In the base-case scenario for men aged 85 years and older, the average lifetime cost associated with THA is $9100 more than nonoperative management, with an average increase in QALE of about 2 years. Thus, the THA cost-effectiveness ratio for men aged 85 years and older is $4600 per QALY gained, less than that of procedures intended to extend life such as coronary artery bypass surgery or renal dialysis. Worst-case analysis suggests that THA remains minimally cost-effective for this oldest age category ($80,000/QALY) even if probabilities, rates, utilities, costs, and the discount rate are simultaneously varied to extreme values that bias the analysis against surgery. CONCLUSIONS: For persons with hip osteoarthritis associated with significant functional limitation, THA can be cost saving or, at worst, cost- effective in improving QALE when both short- and long-term outcomes are considered. Further research is needed to determine whether this procedure is actually being used in this cost-effective manner, especially in older age categories.

Age Factors↗
PubMed1997

Total hip arthroplasty in neglected congenital dislocation of the hip.

Between 1984 and 1995, 74 total hip replacements were performed in 64 adult patients who had painful untreated congenital dislocation of the hip. The arthroplasty was performed in the position of the true acetabulum in all patients who had either high or low congenital dislocations of the hip. The femoral head was positioned in the true acetabulum after either osteotomy of the greater trochanter or shortening of the femur, or progressively using external fixation. Information was available on all patients with a followup of 1 to 11 years (mean, 7.2 years). Of the 74 replaced hips, 70 showed marked improvement concerning pain, gait, and mobility, according to the Merle D'Aubigne and Postel scale. Four hips were revised with satisfactory results. The reason for revision was infection in one case and loosening of the plastic cup in three cases. Shortening of the femur by removing a segment of bone below the level of the lesser trochanter followed by osteosynthesis without osteotomy of the greater trochanter was found to be the best method for treating bilateral and several unilateral high congenital dislocation of the hip.

Adult↗
PubMed1998

Cementless total hip replacement in patients with developmental dysplasia of the hip.

This study was conducted to evaluate the clinical and radiographic results of 22 total hip replacements done in 17 consecutive patients for coxarthrosis due to developmental dysplasia or dislocation of the hip. All operations were done using an anterior approach without trochanteric osteotomy. Standard cementless prostheses were used in all cases. There was no custom-designed prosthesis used. The acetabular cup was placed in an anatomic position in the true acetabulum in every case. Bulk autograft was necessary to reconstruct the deficient acetabular roof in only 2 hips. The average follow-up was 63 months (range, 40 months to 95 months). The average Harris Hip Score was improved from a preoperative value of 35 (range, 24 to 46), to 96 (range, 79 to 100) at final follow-up. To date, no revision has been done. Three hips showed radiographic evidence suggestive of aseptic loosening (2 stems and 1 cup), but the clinical results remain satisfactory. There is no incidence of dislocation, sciatic nerve palsy, or infection.

Acetabulum↗
PubMed2003

Cementless mallory-head HA-coated hip arthroplasty for osteoarthritis in hip dysplasia.

Sixty-three cementless Mallory-Head HA-coated femoral prostheses (Biomet, Warsaw, IN) were used in primary total hip arthroplasty in 50 patients with osteoarthritic hips because of congenital hip dysplasia. The implanted cup was also cementless (41 Harris Galante and 22 Ringlock). The patients were followed up for a mean period of 75.1 months (range, 44-110). Clinical and radiologic analysis were performed. Harris Hip Score increased from 42 to 90 points; 97% of the patients had no or only mild pain, and limping decreased from 90% to 20%. Complications were marginal: no infections, one habitual dislocation, one peroperative fracture of the femur, and one transient ischiadic nerve palsy. Two HG cups were revised for augmented polyethylene wear. Radiographically, no subsidence of the prosthesis or bone atrophy of the proximal femur could be detected. No correlations were found between the radiologic phenomena and the clinical outcome, but the tightness of the prosthesis fit had a definitive influence on the radiographic bone remodeling pattern. The cementless Mallory-Head HA-coated femoral prosthesis shows excellent clinical and radiological mid-term results in osteoarthritic hip dysplasia patients. There was no need for the use of a specially designed dysplasia femoral prosthesis.

Adult↗
PubMed1998

Failed cementless total hip arthroplasty for osteoarthrosis due to hip dysplasia. A minimum five-year follow-up study.

We performed cementless total hip arthroplasty on patients with secondary osteoarthrosis due to hip dysplasia. We conducted prospective radiographic and clinical studies on 75 hips with a minimum five-year follow-up. Aseptic loosening of the Dual geometry Microstructured cup used on the acetabular component was recognized in 2 of 75 hips within five years postoperatively, but neither case required revision. As for the femoral component, within five years of operation, in 9 of 28 (32%) and 11 of 31 (35%) patients, aseptic loosening was recognized in the Omnifit Normalized Smooth surfaced stem (FIT-N) and the Omniflex Normalized Smooth surfaced stem (FLEX-N), respectively, neither of which have a porous coating on their proximal end. Revisions of the stems have been conducted on three FIT-N and two FLEX-N stems. Aseptic loosening was recognized in 2 of 16 Omnifit Microstructured stems (FIT-M) with porous coating, but revisions have not yet been required in these cases. We conclude that stems without a porous surface coating should not be used for cementless total hip arthroplasty.

Adult↗
PubMed1998

Structural integrity of implanted WMT infinity hip and Osteonics Omnifit hip in fresh cadaveric femurs.

Five matched pairs of fresh human femurs were used to quantitatively assess the structural integrity of the implanted Wright Medical Technology modular Infinity hip and the Osteonics single-piece Omnifit hip. The results showed that neither bone implant system was able to recreate the femoral anteversion of the intact femur (p < 0.05). Although the micromotion at the bone-implant interface was well within the limits of achieving bone ingrowth, the axial micromotion was greater for the Infinity hip than for the Omnifit hip (p < 0.05), but the rotational micromotion did not show a significant difference between the two bone implant systems (p > 0.5). The anterior proximal femur deformation patterns were similar for both the two bone implant systems and intact femurs. However, the medial proximal femur deformation patterns showed that the Infinity hip-implanted femur was more similar to the intact femur than the Osteonics Omnifit hip-implanted femur.

Cadaver↗
PubMed2003

Promising outcome of a hip school for patients with hip dysfunction.

OBJECTIVE: To evaluate, in an exploratory study, a hip school led by physical therapists for patients with hip dysfunction including pain. METHODS: Physicians in primary care and orthopedic units consecutively recruited patients by residential area to a treatment group (T group; n = 77) and a control group (C group; n = 68), mean age 61.8 years, 59 men, 86 women. Ninety-nine of the 145 subjects had radiologic hip osteoarthritis. Outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Nottingham Health Profile (NHP). RESULTS: After hip school (6 months) the T group showed greater reduction on the subscales of pain and activity limitations (WOMAC) than the C group. The subscales sleep disturbances, pain, and physical mobility (NHP) showed improvement for the T group compared with at start. The results for the T group persisted after an additional 6 months. CONCLUSION: A hip school may reduce pain and activity limitations and improve health-related quality of life for patients with hip dysfunction including pain.

Adult↗
PubMed1998

How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS Prospective Study.

We conducted a population-based cohort study in 7598 white healthy women, aged 75 years and over, recruited from the voting lists. We measured at baseline bone mineral density (BMD g/cm2) of the proximal femur (neck, trochanter and Ward's triangle) and the whole body, as well as fat and lean body mass, by dual-energy X-ray absorptiometry (DXA). One hundred and fifty-four women underwent a hip fracture during an average 2 years follow-up. Each standard deviation decrease in BMD increased the risk of hip fracture adjusted for age, weight and centre by 1.9 (95% CL 1.5, 2.3) for the femoral neck, 2.6 times (2.0, 3.3) for the trochanter, 1.8 times (1.4, 2.2) for Ward's triangle, 1.6 times (1.2, 2.0) for the whole body, and 1.3 times (1.0, 1.5) for the fat mass. The areas under the receiver operating characteristic (ROC) curves were not significantly different between trochanter and femoral neck BMD, whereas ROC curves of femoral neck and trochanter BMD were significantly better than those for Ward's triangle and whole-body BMD. Women who sustained an intertrochanteric fracture were older (84 +/- 4.5 years) than women who had a cervical fracture (81 +/- 4.5 years) and trochanter BMD seemed to be a stronger predictor of intertrochanteric ([RR = 4.5 (3.1, 6.5)] than cervical fractures ([RR = 1.8 (1.5, 2.3]). In very elderly women aged 80 years and more, hip BMD was still a significant predictor of hip fracture but the relative risk was significantly lower than in women younger than 80 years. In the 48% of women who had a femoral neck BMD T-score less than -2.5, the relative risk of hip fracture was increased by 3, and the unadjusted incidence of hip fracture was 16.4 per 1000 woman-years compared with 1.1 in the population with a femoral neck BMD T-score > or = -1.

Absorptiometry, Photon↗
PubMed1998

Variation in the efficacy of hormone replacement therapy in the prevention of hip fracture. Swedish Hip Fracture Study Group.

Use of postmenopausal hormone replacement therapy (HRT) has been associated with a reduced risk of osteoporotic fractures. However, it is uncertain whether this risk reduction is modified by other risk factors for hip fracture. In a population-based case-control study in Sweden, we investigated the association between HRT and hip fracture risk within categories of age, body measures and lifestyle factors in postmenopausal women, 50-81 years of age. Mailed questionnaires and telephone interviews were used to collect data. Of those eligible, 1328 incident cases with hip fracture (82.5%) and 3312 randomly selected controls (81.6%) answered the questionnaire. Ever use of HRT in women less than 75 years old was associated with an odds ratio (OR) of 0.66 (95% confidence interval: 95% CI 0.50-0.87) for hip fracture compared with OR 0.40 (95% CI 0.21-0.77) in women 75 years or older. We found a significant interaction between HRT and both weight and physical activity (p < 0.05). The protective effect of HRT was particularly pronounced in lean women: compared with never HRT users, ever users weighing under 60 kg had an OR of 0.44 (95% CI 0.30-0.66) whereas women weighing more than 70 kg had an OR of 0.91 (95% CI 0.53-1.56). Women with low recent leisure physical activity (less than 1 h/week) similarly benefited more from HRT for hip fracture prevention than women with a higher degree of recreational physical activity. The observed interactions with weight and physical activity suggest that HRT has the best protective effect against hip fracture among high-risk women.

Age Factors↗
PubMed2005

Prognostic factors influencing the functional outcome of total hip arthroplasty for hip infection sequelae.

To investigate factors influencing functional prognosis for patients who have undergone total hip arthroplasty for late sequelae of infective arthritis of the hip, we conducted a retrospective analysis of 75 hips. All patients had had pyogenic or tuberculous infection and later underwent total hip arthroplasty. The average follow-up period was 5.8 years (range, 3-9 years). Various clinical and radiographic measures were analyzed with respect to Harris hip scores. Younger age at the time of infection onset, preoperative leg length discrepancy greater than 1 in, fusion, severe femoral hypoplasia, and severe acetabular dysplasia were associated with poorer prognosis. The complication rate, including 1 recurrent infection, was relatively low. Previous infections seemed to predict poorer results mostly because of the consequences of infection for the development of the hip joint, rather than because of infection recurrence.

Acetabulum↗