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PubMed2005

Hip arthroscopy after previous acetabular osteotomy for developmental dysplasia of the hip.

PURPOSE: The purpose of this study was to examine the arthroscopic findings in the hips of patients with long-term follow-up of Chiari osteotomies. TYPE OF STUDY: Prospective consecutive series of patients. METHODS: Seven consecutive patients (1 male, 6 female; average age, 23 years) having a Chiari osteotomy performed in 1 hip during childhood or adolescence for developmental dysplasia of the hip were studied. They presented mechanical hip symptoms and had adequate head coverage as a result of the osteotomy with preservation of joint space. Hip arthroscopy was performed in all cases. RESULTS: A massive labral tear dislocated in the midportion of the joint was found in all cases with varying degrees of cartilage damage in the acetabulum or femoral head. The labral tear was resected, cartilage lesions were repaired, and microfracturing of the exposed subchondral bone was performed. Mechanical symptoms improved after surgery and all of the patients were able to go back to activities of daily living. CONCLUSIONS: In the Chiari osteotomy, medial displacement of the acetabulum leaves the labrum in the center of the load-bearing area of the resulting acetabulum. Over time this can produce a tear of the labrum, which may be the cause of the mechanical symptoms in our series. It has been documented that labral tears can lead to early degenerative hip disease and, combined with the cartilage lesions, may explain in part the long-term bad results of the Chiari osteotomy. LEVEL OF EVIDENCE: Level IV.

Acetabulum↗
PubMed2006

Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation.

OBJECTIVE: To compare the fixation stability in the femoral head with sliding hip screw versus helical blade designs for unstable, intertrochanteric hip fractures. METHODS: A simulated, unstable intertrochanteric hip fracture was created in six pairs of cadaveric femurs. One of each pair was treated using an intramedullary nail with a sliding hip screw (ITST) for femoral head fixation and the other was treated with a nail with a helical blade (TFN). Each specimen was cyclically loaded with 750N vertical loads applied for 10, 100, 1000 and 10,000 cycles. Measurements for femoral head displacement, fracture fragment opening and sliding were made. Specimens were then loaded to failure. RESULTS: There was significantly more permanent inferior femoral head displacement in the ITST samples compared to the TFN samples after each cyclic loading (all p values<0.05). There was significantly more permanent fracture site opening and inferior displacement in the ITST group compared with the TFN group at 1000 and 10,000 cycles (p<0.05). Final loads to failure were not significantly different (p=0.51) between the two treatment groups. Nine specimens demonstrated fracture extension into the anteromedial cortex and subtrochanteric region and three specimens, which had an ITST implant, demonstrated a splitting fracture of the femoral head. CONCLUSION: This study demonstrated that fixation of the femoral head with a helical blade was biomechanically superior to fixation with a standard sliding hip screw in a cadaveric, unstable intertrochanteric hip fracture model.

Biomechanical Phenomena↗
PubMed2002

Intramedullary hip screw versus sliding hip screw for unstable intertrochanteric femoral fractures in the elderly.

We report a randomised, prospective study comparing a standard sliding hip screw and the intramedullary hip screw for the treatment of unstable intertrochanteric fractures in the elderly. One hundred and two patients were randomised on admission to two treatment groups. Fifty-two patients were treated with a compression hip screw (CHS), and fifty had intramedullary fixation with an intramedullary hip screw (IMHS). Patients were followed for 1 year and had a clinical and radiological review at 3, 6 and 12 months. The mean duration of operation and fluoroscopy screening time was significantly greater for insertion of the intramedullary hip screw. There was no difference between the groups with regard to transfusion requirements or time to mobilise after surgery. There were two technical complications in the CHS group and three in the IMHS group. There was no significant difference between the two groups in radiological or functional outcome at 12 months. It remains to be shown whether the theoretical advantages of intramedullary fixation of extracapsular hip fractures bring a significant improvement in eventual outcome.

Aged↗
PubMed2001

Paediatric hip--ultrasound screening for developmental dysplasia of the hip: a review.

This paper will try to deal with the following questions: Which is the correct screening model for the developmental dysplasia of the hip (DDH)? What is the clinical significance of "sonographic" DDH? Can overtreatment produced by ultrasound (US) screening cause a waste of resources and eventually morbidity? We reviewed the literature since January, 1996 through December, 2000. To compare our experience with the literature, we analysed the results of the US examinations of the hip performed in our Institute. Over 4 years of US screening 11326 infants (22652 hips), aged 3 days to 4 months, were examined consecutively. Sonographic hip findings were abnormal in 531 infants (4.7%). The screening showed 381 subjects (3.36% of the population) with a type IIa hip (bilateral or unilateral); 65% of these infants were normal at follow up and only 35% worsened. On the whole we treated 282 infants (2.5%). No open reduction was performed. Avascular necrosis appeared in 2/282 treated cases (1.06%). We support the routine generalised US screening of neonatal hips. The excess of doubtful cases and, consequently, of the extra referrals may be limited, and the overtreatment decreased to the lowest rates reported by optimisation of everyone's approach.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Inpatient rehabilitation of patients following total hip replacement--a study using the Harris hip score].

AIMS: The aim of the study was to evaluate the outcome of inpatient rehabilitation following total hip arthroplasty using the Harris hip score. Factors influencing the result were analysed. METHOD: 338 patients admitted to a rehabilitation unit after total hip replacement were included in a prospective study. There were 252 female and 86 male patients, with a mean age of 69 (+/- 9.7) years (range, 34 to 88 years). RESULTS: At admission the Harris hip score was 63.1 (+/- 10.4) and was improved by almost 25 % to 79.1 (+/- 7.1) at discharge. The percentage of patients with a poor score was decreased from 71.9 % to 8 % after rehabilitation. The result of rehabilitation was independent of sex, age, concomitant diagnoses or weight bearing. 61 patients could not be discharged after three weeks as usual and stayed for another 8.0 (+/- 4.5) days. At admission these patients had significantly lower scores (58.5 +/- 10.8) than the patients who stayed for three weeks (64.1 +/- 10.0). At discharge scores were comparable with 77.0 (+/- 7.2) and 79.6 (+/- 7.0), respectively. CONCLUSION: An inpatient rehabilitation after hip arthroplasty significantly improves the Harris hip score independent of sex, age, concomitant diseases and weight bearing.

Activities of Daily Living↗
PubMed1997

Risk factors for hip fracture in men. Hip Fracture Study Group.

To identify risk factors for hip fracture in men, the authors conducted a case-control study involving 20 hospitals in Philadelphia, Pennsylvania, and 14 hospitals in Kaiser Permanente Medical Care Program of northern California. The 356 enrolled men had been admitted with a radiologically confirmed first hip fracture. The 402 control men either were from the Philadelphia area or were members of Kaiser Permanente and were frequency matched to the cases by age and ZIP code or telephone exchange. Information on potential risk factors was obtained through personal interviews. Men in the lowest quintile of body mass had a greatly increased risk of hip fracture compared with men in the heaviest quintile (odds ratio (OR) 3.8, 95% confidence interval (CI) 2.3-6.4). Premorbid lower limb dysfunction was associated with increased risks for hip fracture (OR 3.4, 95% CI 2.1-5.4). Increased risks were also observed with the use of cimetidine (OR 2.5, 95% CI 1.4-4.6) and psychotropic drugs (OR 2.2, 95% CI 1.4-3.3). Smoking cigarettes or a pipe increased the risk of hip fracture, and this association was independent of body mass. Finally, previous physical activity was markedly protective. Factors thought to affect bone density as well as factors identified as risk factors for falls appear to be important determinants of the risk of hip fracture in men. Physical activity may be a particularly promising preventive measure for men. Additional studies of the use of cimetidine on osteoporosis and osteoporotic fractures are indicated.

Activities of Daily Living↗
PubMed2000

Body size and hip fracture risk. Swedish Hip Fracture Study Group.

The objective of this population-based case-control study was to determine the independent association between height, weight at different ages and adult weight change on hip fracture risk, and the joint effects of these factors. The study base comprised postmenopausal women 50-81 years of age who resided in six counties in Sweden during the period October 1993 to February 1995. The study included 1,327 cases with an incident hip fracture and 3,262 randomly selected controls. We obtained information on body measures and other factors possibly related to hip fracture through mailed questionnaires and telephone interviews. Height and weight change were dominant risk factors. Tall women (> or = 169 cm) had an odds ratio of 3.16 (95% confidence interval = 2.47-4.05) compared with women shorter than 159 cm. Weight gain during adult life was strongly protective: compared with those with moderate weight change (-3 to 3 kg), those with substantial weight gain (> or =12 kg) had a markedly decreased risk of hip fracture (odds ratio = 0.35; 95% confidence interval = 0.27-0.45), whereas weight loss was associated with an increased risk. Weight change retained important effects among all subjects, even after controlling for current weight and weight at age 18. In contrast, among women who gained weight, the separate effects of current weight and weight at age 18 were small or absent. Among women who lost weight, both current weight and weight at age 18 had effects that remained after controlling for weight change. Adult weight change and height are dominant body size risk factors for hip fracture. Weight loss vs weight changes demarcates different patterns of hip fracture risk.

Age Distribution↗
PubMed2002

Force reduction by an external hip protector on the human hip after falls.

This is the first quantitative study of the impact force over the hips of volunteers who fell laterally from standing to a hard surface while wearing a hip protector. Protector pads were first tested with a drop weigh machine. Piezoelectric sensors were placed on the impact surface to record force-time curves with and without a pad covering the surface. Two types of pads transmitted only 9% of the force at a drop weight impact force of 13,372 N. Sensors were placed over the hip under a protective hip pad worn by 10 volunteers who deliberately fell from standing, to a concrete surface. Only 5% or less impact force was transmitted to the skin sensors, and no hip injuries occurred after 85 falls, providing evidence for the safety of such falls. Only transient skin pain and tenderness occurred in three volunteers. Force transmission through the pads was well below that required to fracture hips from cadavers with osteoporosis in vitro. There was variability in the reduction of force transmission among the volunteer subjects. A 1-month compliance study with 106 elderly subjects showed protector use for 70% to 95% of their hours out of bed.

Accidental Falls↗
PubMed2005

Surgical treatment of intertrochanteric hip fractures with associated femoral neck fractures using a sliding hip screw.

OBJECTIVE: The purpose of this study was to report the results of surgical treatment of a subset of intertrochanteric fractures with posteromedial comminution and extension of the fracture line into the femoral neck using a sliding hip screw. DESIGN: Retrospective review. SETTING: Level I county trauma center. PATIENTS: Twenty-nine fractures (8%) with this pattern were identified from 381 intertrochanteric hip fractures treated at a single institution over a 10-year period. Nine patients were excluded (2 died, 7 had incomplete radiographic follow-up), leaving 20 patients for assessment. INTERVENTION: All fractures were treated with a sliding hip screw. MAIN OUTCOME MEASUREMENTS: Radiographs at a mean follow-up of 17 months were recorded as demonstrating: 1) fixation failure; 2) fracture union; or 3) fracture nonunion. The tip-apex distance, amount of lag screw collapse, screw position in the femoral head, and adequacy of reduction were determined. RESULTS: Treatment failed according to these radiographic measures in 5 of 20 (25%) fractures. Failures included fracture nonunion (1 case), lag screw cutout (2 cases), and combined nonunion/lag screw cutout (2 cases). All 5 failures had complete collapse of the lag screw, whereas 4 of the 15 successfully treated fractures had complete collapse. The amount of collapse was significantly greater for the treatment failures (mean, 38 mm) than in the successfully treated hips (mean, 20 mm). There was no significant association between treatment success or failure and tip-apex distance, lag screw position, and adequacy of reduction. CONCLUSION: We conclude that intertrochanteric hip fractures with associated femoral neck fractures should not be managed with a standard sliding hip screw.

Adult↗
PubMed2006

Simultaneous ipsilateral posterior knee and hip dislocations: case report, including a technique for closed reduction of the hip.

In isolation, dislocations of the hip and knee require emergent reduction to minimize the risks of serious complications, including vascular and neurologic injury, osteonecrosis of the femoral head, and loss of motion and function. With simultaneous dislocation of the ipsilateral hip and knee, as in the situation of hip dislocation with concomitant femoral shaft fracture, reduction of the hip may prove difficult because of the inability to control the femoral segment. In this setting, general anesthesia is commonly required. We present the case of a patient who sustained an ipsilateral hip and knee dislocation who underwent closed reduction of the knee in the emergency department but required general anesthesia and the insertion of Schanz pins in the femur to reduce the hip dislocation.

Accidents, Traffic↗
PubMed1977

Total hip replacement in the previously infected hip.

Ten patients with a history of previous hip joint sepsis including one with active tuberculosis of the hip have had total hip replacement using acrylic cement. With duration of follow-up ranging from six months to over three years, all but one have had satisfactory results with no evidence of persistent or recurrent infection. When preceded by thorough evaluation and eradication of hip sepsis, total hip arthroplasty appears to be an acceptable procedure for restoring a functional hip joint in patients with this difficult problem.

Adult↗
PubMed2006

The other hip in unilateral hip dysplasia.

UNLABELLED: We reviewed transverse pelvic computed tomography scans of 197 consecutively referred adult patients with hip pain thought to be secondary to developmental dysplasia. A center-edge angle of 20 degrees or less was considered the upper normal value. Four groups were identified: 69 patients with apparently unilateral right developmental dysplasia (left hip center-edge angles greater than 20 degrees), 26 patients with apparently unilateral left developmental dysplasia (right hip center-edge angles greater than 20 degrees), 68 patients with bilateral developmental dysplasia, and 34 patients with bilateral borderline developmental dysplasia (bilateral center-edge angles less than or equal to 25 degrees). The pelvic computed tomography scans were compared with computed tomography scans of 41 control subjects with healthy hips. The joint anatomy of patients with developmental dysplasia differed from that of control subjects in almost all aspects. Acetabular anteversion was larger in control subjects compared with patients with developmental dysplasia. We found inverse relationships between femoral anteversion and the anterior acetabular sector angle and coronal and sagittal center-edge angles in dysplastic hips, and also between femoral neck-shaft angles and the anterior acetabular sector angle. There was an inverse relationship between reduced anterior support developmental dysplasia in which plain radiographs suggested unilateral dysplastic abnormality only, computed tomography scans revealed both hips to be abnormal. The data suggest that patients referred with seemingly unilateral developmental dysplasia also are at risk of having contralateral dysplastic malformation. LEVEL OF EVIDENCE: Diagnostic study, Level II (development of diagnostic criteria on consecutive patients [with universally applied reference "gold" standard]). See the Guidelines for Authors for a complete description of levels of evidence.

Acetabulum↗
PubMedDate not supplied

Relationship of pain to the radiological anatomy of the hip joint in adults treated for congenital dislocation of the hip as infants: a long-term follow-up of patients treated by three methods.

Sixty female patients with congenital dislocation of the hip treated by three methods were followed up to a mean age of 27.3 years. Standard radiographic measurements of hip joint morphology, including stereoscopic measurements of acetabular and femoral neck anteversion, were made. The Severin score of the hip joint, but not acetabular or femoral neck anteversion, was related to symptoms. Hips treated by femoral derotation osteotomy had superior results to hips treated by traction reduction alone. Both of these methods gave much better results than treatment by closed manipulative reduction. The "normal" opposite hip was morphologically abnormal, although usually asymptomatic.

Female↗
PubMed1978

Plasma, bone, hip capsule and drain fluid concentrations of ampicillin and flucloxacillin during total hip replacement after intravenous bolus injection of magnapen.

1. A rapid intravenous bolus injection of 4.0 g Magnapen (which contains 2.0 g of ampicillin and 2.0 g of flucloxacillin) was to seven patients undergoing total hip replacement immediatly before induction of general anesthesia. Postoperatively the patients patients received 2.0 g Magnapen by intramuscular injection every 6 h for up to 72 h until removal of the wound drains. 2. The plasma, bone, hip capsule and drain fluid concentrations of ampicillin and flucloxacillin were measured by a differential small plate microbiological assay method using Sarcina lutea and a penicillinase producing Staph. aureus Russell as the test organisms. 3. The mean +/- s.e. mean concentrations of ampicillin after this regimen were 4222.2 +/- 285.0 microgram/ml (plasma), 65.6 +/- 1.3 microgram (g (hip capsule), 19.1 +/- 3.8 microgram/g (cancellous bone), and 211.1 +/- 65.6 microgram/g (ground up bone) respectively. 4. The mean +/- s.e. mean flucloxacillin concentrations after this regime were 137.2 +/- 28.4 microgram/ml (plasma), 61.8 +/- 15.0 microgram/g (hip capsule), 47.1 +/- 9.5 microgram/g (cancellous bone) and 139.4 +/- 21.8 microgram/g (ground up bone) respectively. 5. An intravenous bolus injection of Magnepen (4.0 g), given immediately before induction of general anaesthesia, provides concentrations of ampicillin and flucloxacillin in plasma, hip capsule, cancellous and ground up bone, and drain fluid that exceed the MICs of these antibiotics against Staph. aureus and E. coli. 6. The plasma, hip capsule, cancellous and ground up bone concentrations of ampicillin after this dose of Magnapen do not, however, exceed the MICs of the Gram negative anaerobes that sometimes cause postoperative wound infections in these patients.

Aged↗
PubMed2000

Health impact of pain in the hip region with and without radiographic evidence of osteoarthritis: a study of new attenders to primary care. The PCR Hip Study Group.

OBJECTIVES: To assess the health impact of hip pain at the time of first presentation to primary care, and the influence on this of radiographic evidence of osteoarthritis. SUBJECTS AND METHODS: Cross sectional survey of 195 patients (63 male, 132 female), aged 40 years and over, presenting with a new episode of hip pain, recruited from 35 general practices across the UK. Health status at presentation was determined by a structured questionnaire on symptoms, healthcare use, and health related quality of life (SF-36). Pelvic radiographs were assessed blindly for hip osteoarthritis using standard scoring systems. RESULTS: The overall impact on health was substantial. Before their first consultation, three quarters of patients needed analgesics, half used topical creams or ointments, and one in eight used a walking stick. Most of these impact measures were, however, unrelated to the degree of radiographic change, though use of a walking stick was increased in those with the most severe damage. Health status, as judged by the SF-36, was also impaired for measures of physical function and pain, but the impact on the "mental health", "general health", and "vitality" dimensions was small. There was a weak relation between the SF-36 scores and radiographic change, with many domains unrelated to the severity of radiographic damage. CONCLUSIONS: This study is the first to show the therapeutic impact and pattern of impairment in health status resulting from hip pain at the time of first presentation to the healthcare services. Unlike many regional pain syndromes seen in primary care, such as back pain, hip pain does not impact on wider aspects of quality of life, such as general health status, mental health, or vitality. Furthermore, any impact of hip pain in this group is not markedly influenced by the degree of structural damage. Further follow up is required to determine whether such damage influences the persistence of any adverse impact.

Adult↗
PubMed1993

Hip aspiration: a cost-effective and accurate method of evaluating the potentially infected hip prosthesis.

PURPOSE: The accuracy of fluoroscopy-guided hip aspiration in the diagnosis of infection in hip prostheses was evaluated. MATERIALS AND METHODS: Results from 147 preoperative aspiration cultures were compared with results of operative cultures. The relative costs of aspiration and nuclear medicine studies were also compared. RESULTS: With the operative culture results as the standard, sensitivity of hip aspiration was 92.8% and specificity was 91.7%. The negative and positive predictive values were 99.2% and 54.2%, respectively. Aspiration arthrography costs approximately 20% as much as complementary technetium sulfur colloid-indium-111 granulocyte scans, the most accurate nuclear medicine study used to evaluate potentially infected hip prostheses. CONCLUSION: Hip aspiration is an accurate and cost-effective method of evaluating the potentially infected hip prosthesis.

Bacteria↗
PubMed2002

Hip surveillance in children with cerebral palsy. Impact on the surgical management of spastic hip disease.

We studied prospectively the impact of a hip surveillance clinic on the management of spastic hip disease in children with cerebral palsy in a tertiary referral centre. Using a combination of primary clinical and secondary radiological screening we were able to detect spastic hip disease at an early stage in most children and to offer early surgical intervention. The principal effect on surgical practice was that more preventive surgery was carried out at a younger age and at a more appropriate stage of the disease. The need for reconstructive surgery has decreased and that for salvage surgery has been eliminated. Displacement of the hip in children with cerebral palsy meets specific criteria for a screening programme. We recommend that hip surveillance should become part of the routine management of children with cerebral palsy. The hips should be examined radiologically at 18 months of age in all children with bilateral cerebral palsy and at six- to 12-monthly intervals thereafter. A co-ordinated approach by orthopaedic surgeons and physiotherapists may be the key to successful implementation of this screening programme.

Adolescent↗
PubMed2004

The ferguson medial approach for open reduction of developmental dysplasia of the hip. A clinical and radiological review of 49 hips.

The results of the Ferguson medial approach for open reduction of developmental dysplasia of the hip (DDH) were reviewed for 49 hips with a follow-up of more than 48 months. The mean age at operation was 12.3 months (6 to 23). The mean length of clinical and radiological follow-up was 82 months (48 to 148). Three redislocations occurred. Group I avascular necrosis according to the classification of Kalamchi and MacEwen was seen in four hips, group II in two hips and group III in one hip; 92% of the hips were classified as Severin class I and II. The acetabular index and centre edge (CE) angles were within normal limits at final follow-up, but were still significantly different from the unaffected side. We conclude that the Ferguson procedure is safe and reliable for low dislocations in children aged six to 18 months.

Acetabulum↗