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[Accumulation velocity of 99mTc-HMDP in hip joint diseases].

The accumulation rate and velocity of 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP) in hip joints were determined within four minutes after a bolus of injection of 99mTc-HMDP in the patients with hip joint disorders. There exist a significant relationship between accumulation velocity of 99mTc-HMDP in the affected joint and serum osteocalcin in the patients with eight cases of degenerative osteoarthropathy and six cases of femoral necrosis. This result indicates that the accumulation velocity of 99mTc-HMDP in the affected joint is likely to become a marker of bone turnover in hip joint disorder.

Adult↗

Traumatic hip joint tamponade. Two cases with femoral head ischaemia.

Two elderly patients had pain after hip trauma with no radiographic evidence of fracture. Computed tomography demonstrated capsular haematoma. Scintimetry revealed femoral head ischaemia. Intracapsular hip joint pressure in extension was 240 and 176 mm Hg, respectively, in neutral position and 280 and 360 mm Hg in internal rotation. The hip joints were aspirated for 8 ml and 5 ml of blood, respectively, leading to pain relief and regained radiotracer uptake in the femoral head. It is concluded that traumatic hip joint tamponade may cause femoral head ischaemia which may be reversed by aspiration.

Accidents, Home↗

Rheumatoid synovial cyst of the hip joint: a case report.

Rheumatoid synovial cyst of the hip joint in a 52-year-old man including iliopsoas bursal extension was demonstrated by arthrography and excision biopsy. Surgical excision of the cyst and femoral head replacement were carried out. There was no recurrence for 15 months postoperatively. The condition should be suspected in patients with degenerative changes in the hip joint and adjacent unexplained palpable mass.

Arthritis, Rheumatoid↗

[Biodynamics of the hip joint. The elasticity of the human femur and its importance].

Pauwels' biomechanical analysis of hip joint function shows that the dynamic forces acting on the joint can be large. In these techniques, spring mechanisms are being used to neutralize dynamic forces. The question remains as to whether such a mechanism in humans exists in the vicinity of the hip joint, i.e. in the femur. Fresh human femoral bones were put under axial stress and their qualities examined. Different spring qualities were found in the various femora; and by comparing these, 6 groups were established which were then subjected to statistical analysis. More than half the bones examined possessed good spring qualities. A practical example proves that the spring qualities of the femur are apt to absorb a considerable amount of kinetic energy during the axial stress and thus lessen the vertical mechanical strain vector of the hip joint.

Biomechanical Phenomena↗

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↗

Amyloid in osteoarthritic hip joints: deposits in relation to chondromatosis, pyrophosphate, and inflammatory cell infiltrate in the synovial membrane and fibrous capsule.

The relationship between osteoarthritic change and amyloid degeneration was studied in 116 joint capsules from osteoarthritic hip joints. Twenty-seven (23%) contained amyloid deposits. Twenty-eight joint capsules showed chondroid metaplasia in the fibrous part. Significantly more amyloid degeneration was found among these. Six joint capsules contained pyrophosphate crystals. Five of these were positive for amyloid. Chronic inflammation of the joint capsule was found in 80% of the cases and was negatively correlated with amyloid degeneration, which is in good agreement with the biphasic theory for the pathogenesis of amyloid. Further investigation is necessary to decide how chondroid metaplasia takes part in the production of amyloid.

Adult↗

Association of HLA-DR and HLA-DQ antigens with congenital dislocation and dysplastic osteoarthritis of the hip joints in Japanese people.

OBJECTIVE: To investigate the frequency of HLA-DR and DQ antigens among patients with congenital dislocation of the hip joint or dysplastic osteoarthritis (OA) and to determine whether tissue typing might contribute to better understanding of these disorders. METHODS: HLA-DR and DQ typing was undertaken in 18 patients with congenital dislocation of the hip joints, 65 patients with dysplastic OA of the hip, 42 patients with primary OA of the knee, and 40 normal controls. Typing for HLA-D antigens was performed using the standard microlymphocytotoxicity method. RESULTS: The frequency of HLA-DR4 in patients with congenital dislocation of the hip joint (61.1%) and patients with dysplastic OA of the hip (58.5%) was significantly increased compared with normal controls (27.5%) (Pcorr < 0.05 and P < 0.01, respectively). The relative risk for HLA-DR4 was 4.1428 and 3.7104, respectively, in these 2 disease groups. The frequency of HLA-DR4 in the patients with primary OA of the knee (35.7%) did not differ significantly from that in normal controls. CONCLUSION: The results strongly indicate that development of congenital dislocation of the hip joint and progression of dysplastic OA of the hip are associated with genes of the HLA-D region.

Aged↗

[Sitting posture after arthrodesis of the hip joint or lumbosacral fusion (author's transl)].

The sitting posture of persons with arthrodesis of the hip joint and with lumbosacral fusion are analyzed. It is shown that any disorder in the hip joint - pelvis - lumbar spine system results in a change of posture. In particular, a defective hip joint produces an unfavorable posture by folding over the lumbar spine. The effect of fusion of the lumbosacral area on sitting posture is less marked.

Adult↗

Factors relating to hip joint arthritis following three childhood diseases--juvenile rheumatoid arthritis, Perthes disease, and postreduction avascular necrosis in congenital hip dislocation.

This article discusses factors that relate to the prognosis for development of hip joint arthritis following juvenile rheumatoid arthritis (JRA), Perthes disease, and postreduction avascular necrosis in congenital hip dislocation (CDH). In JRA, the integrity of the articular cartilage determines prognosis. In Perthes disease, prognosis is strictly related to the shape of the hip. In postreduction avascular necrosis in CDH, half the patients have a prognosis primarily related to hip joint shape, and half have a prognosis apparently more related to the integrity of the articular cartilage.

Adult↗

Laxity of canine hip joint in two positions with computed tomography.

Computed tomographic (CT) examination of 20 canine hip joints was carried out in two positions, normal-standing and weight-bearing. In normal (dorsal acetabular rim angle: DARA < 15 degrees ) or slightly abnormal (DARA, 15 degrees to 20 degrees ) hip joints, the values of parameters to laxity were evaluated as more severe in the weight-bearing position. Comparisons of results using various indicators, including the center distance (CD) index, dorsolateral subluxation score, and lateral center edge angle, revealed that the CD index may be a useful marker of functional laxity in the canine hip joint under CT scanning. Further, CT scanning in the weight-bearing position was more sensitive than in the normal-standing position for the detection of laxity in hips with normal or only slightly abnormal DARA.

Acetabulum↗

Gait analysis in an osteoarthritis patient with restoration of the hip joint space following contralateral total hip arthroplasty: a case report.

We present the case of a patient who, after undergoing unilateral total hip arthroplasty (THA), achieved pain reduction in the contralateral hip accompanied by restoration of the radiographic joint space. We conducted gait analysis to clarify the dynamic factors affecting the natural course of osteoarthritis (OA). Our findings revealed that the patient walked with exaggerated adduction of the hip following the contralateral THA, causing substantial regeneration of joint loading.

Journal Article↗

Some histological aspects of the hip joint capsule in the vervet monkey.

Microscopic studies show that the capsule of the hip joint in the vervet monkey (Cercopithecus aethiops pygerythrus) is preponderantly collagenous. Among the collagen fiber bundles are varying quantities of elastic fibers that demonstrate a definite, differential regional distribution. The highest concentration of elastic tissue is found in the posterior, postero-inferior, and inferior aspects of the hip joint capsule, whereas the anterior and superior aspects of the capsule are preponderantly collagenous. It is postulated that this regional distribution of elastic tissue is related to the differential functional requirements of the posterior, postero-inferior, and inferior aspects of the capsule for flexibility and stretchability. These requirements appear to be a consequence of the habitual postures and locomotory positions assumed at the hip joint by these primarily quadrupedal primates. Collagen, on the other hand, being much more resistant to deformation and relatively noncompliant, is the predominant tissue in the anterior and superior aspects of the joint.

Animals↗

Radiographic determination of the anatomic hip joint center. A cadaver study.

We studied 31 human pelvic cadaver specimens with 57 intact hip joints. The teardrop, which represents the inferior portion of the acetabular notch, was identified as also was the center of rotation in the articulating femoral head. The pelvic height and the horizontal and vertical distances between the acetabular notch and the hip joint center were measured. We found the center of rotation of the hip joint to be 13 percent of the pelvic height lateral and 7 percent of the pelvic height superior to the teardrop. No sex difference was found.

Aged↗

Dependence of EMG-reaction times of the rectus femoris on position changes of the hip joint--role of the joint capsule.

EMG-reaction times (EMG-RTs) of the rectus femoris in midposition (M) and internally rotated position (IR) of the right hip joint were examined in nine control subjects and nine patients who had lost most of the capsule of a hip joint after total hip joint replacement procedure. In both groups EMG-RTs of the rectus femoris were faster at IR than at M. The difference of EMG-RTs between M and IR was essentially the same in the two groups. It is assumed that information from proprioceptors in the joint capsule may not play an important role in postural dependence of EMG-RTs of the muscle.

Adult↗

The femoral artery and flexion of the hip joint.

The behavior of the femoral a. when the hip joint passes from the position of extension to the position of flexion at 90 degrees was studied in 13 cadavers, using several methods: anatomic sections, arteriographies or vascular casts. The modifications of the direction and shape of the femoral a. were assessed in the frontal and sagittal planes. They result from a movement combining flexion and torsion of the femoral a. on its axis at 2 different points in its course. The change of direction of the artery in the sagittal plane is the most obvious modification. It corresponds to the displacement and to the inversion of an angle of 45 degrees on the course of the artery. This angle is situated below the level of the inguinal ligament when the hip joint is in extension and above the sartorius m. when it is flexed to 90 degrees. If these modifications are produced in a similar manner in the living subject, they would seem to correspond to the best possible functional adaptation of the femoral a. They may be involved in the genesis of prosthetic aneurysms.

Blood Vessel Prosthesis↗

Difficult complications after hip joint replacement. Dislocation.

Dislocation after hip replacement occurs at an overall incidence of 2% to 3% and has significant cost and morbidity implications. Statistically increased incidence is observed in females and in the elderly, and after reoperation procedures. Specific causes include cup malrotation, trochanteric migration, and decreased femoral offset. Head size, leg length, and postoperative mobilization have not proven to be causative factors, but the posterior exposure statistically and consistently is associated with increased instability. Extended acetabular walls do lessen the incidence of dislocation in the primary but even more significantly in the revision procedure. Early (< 3 months) dislocations successfully are treated by 4 to 8 weeks of immobilization in 60% to 70% of instances. The most successful reoperations are those in which the specific cause of the dislocation has been defined. The success rate is approximately 80% for cup reorientation and trochanteric advancement. Nonspecific or ill defined causes are managed successfully by surgical intervention in only approximately 50% of cases. With extensive soft tissue compromise, limited experience with certain salvage options include the bipolar implant with a reported success rate of approximately 80%. Captive articular designs also seem to be successful in approximately 70% of instances but with relatively short term followup and lingering concerns regarding the long term integrity of the fixation.

Arthroplasty, Replacement, Hip↗

Quantitative determination of joint incongruity and pressure distribution during simulated gait and cartilage thickness in the human hip joint.

The objective of this study was to provide quantitative data on hip-joint incongruity and pressure during a simulated walking cycle and on articular-cartilage thickness in the same set of specimens. Using a casting technique in eight specimens of the human hip (age: 18-75 years), we determined the width of the joint space (incongruity) required at minimal load for contact at four phases of the gait cycle. The pressure distribution, measured with pressure-sensitive film, was determined at physiologic load magnitudes on the basis of in vivo measurements of hip-joint forces. Cartilage thickness was assessed with A-mode ultrasound. At minimal loading, the average maximum width of the joint space ranged from 1.1 to 1.5 mm in the acetabular roof, with the contact areas located ventro-superiorly and dorso-inferiorly throughout the gait cycle. At physiological loading, the width decreased and the contact areas covered the complete articular surface during midstance and heel-off but not during heel-strike or toe-off. The pressure distribution was inhomogeneous during all phases, with average maximum pressures of 7.7 +/- 1.95 MPa at midstance. The cartilage thickness varied considerably throughout the joint surfaces; maxima greater than 3 mm were found ventro-superiorly. These data can be used to generate and validate computer models to determine the load-sharing between the interstitial fluid and the solid proteoglycan-collagen matrix of articular cartilage, the latter being relevant for the initiation of mechanically induced cartilage degeneration.

Adolescent↗