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At least 397 records · Page 22Linked to original sources
PubMed2003

Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip.

INTRODUCTION: Total joint replacement in patients suffering from developmental dysplasia of the hip poses specific technical difficulties due to insufficient bone stock at the site of the original and secondary acetabulum and a narrow, cranially displaced proximal femur. MATERIALS AND METHODS: Twelve hips with severe congenital dislocation (4 Crowe type II, 5 type III, 3 type IV) were treated with cementless, porous structured total hip replacement. The cup was implanted at the anatomic height, a femoral segment was resected below the minor trochanter to reduce the femoral component in all cases. RESULTS: One femoral component was exchanged for a longer stem after 2 months due to insufficient fit and fill. After a mean follow-up of 5.1 years, there were no further revisions or radiographic signs of loosening. No cup was revised or loose radiographically. Harris hip score (mean) improved from 36 to 82 points, mean leg length discrepancy was reduced from 5.4 to 1.3 cm. CONCLUSION: The cementless technique described is useful in cases of severe congenital dislocation of the hip when the cup is implanted at the anatomic level, and implant reduction is not possible despite thorough soft-tissue release or not advisable because of excessive limb lengthening. A reconstruction of the original joint center and good mid-term results are demonstrated.

Adult↗
PubMed2000

Cemented Lubinus and Furlog total hip endoprosthesis: a 12-year follow-up study of 175 hips comparing the cementing technique.

We analyzed 175 total hip replacements with cemented Lubinus and Furlong arthroplasties in 164 patients with a median age of 65 (32-80) years and followed them for 12 years to evaluate and compare the efficacy of total hip prosthesis designs. Survival analysis was combined with an analysis of radiological findings and a study of functional outcome of the patients. The 12-year survival of Furlong arthroplasty in patients of 60 years of age and older was O.85 (95% CI 1.00-0.52). The survival of Lubinus arthroplasty in patients younger than 60 years of age was 0.70 (0.91-0.48), while the survival in older patients was 0.75 (0.89-0.61). The 12-year survival of well-cemented Lubinus prosthesis was 0.91 (1.00-0.79), indicating the importance of the cementing technique. The survival of the cups was marginally better than that of the stems. In the 12-year follow-up study, the clinical state and function varied from hips ready for revision to hips where a continuously long survival could be predicted. Harris hip score did not differentiate between patients who had intact and loose components. We conclude that cemented arthroplasty affords a notable alternative with satisfactory long-term survival and function. The better survival of cemented cup than the stem may be utilized as a basis for "reverse" hybrid arthroplasty. Adequate long-term follow-up of all arthroplasties as a quality maintenance and to prevent difficult revisions is a major challenge.

Adult↗
PubMed2005

Total hip arthroplasty in developmental high dislocation of the hip.

In total hip arthroplasty for developmental high dislocations, placement of the implant cup in the true acetabulum and femoral-shortening osteotomy can produce satisfactory results. We performed total hip arthroplasties in 25 high dislocated hips (22 patients) between 1992 and 2000, placing all cups in the true acetabula and using noncemented components and performing a femoral-shortening osteotomy in 22 hips. The overall complication rate was 36%. At follow-up evaluation at an average of 5 years later, patients' mean scores had improved as follows: pain, from 2.3 to 5.7; function scores, from 2.3 to 4.5; mobility scores, from 2.3 to 4.4; Harris hip scores, from 37.8 to 95. We recommend both placing the cup in the true acetabulum to maximize host-bone contact with the implant and preserve as much host bone as possible and femoral-shortening osteotomy for a lower incidence of nerve injury than with aggressive soft-tissue release.

Adult↗
PubMed2006

Simultaneous primary total hip arthroplasty and contralateral revision hip arthroplasty: role for use of femoral head autograft.

We report the outcome of revision hip arthroplasty for patients with acetabular bone loss in whom the femoral head retrieved from arthritic contralateral hip during the same anesthesia was used as autograft for acetabular reconstruction. Thirty-two hips in 16 patients with a mean age of 63.8 years (range, 43-79 years) were followed for an average of 3.5 years. All primary arthroplasties were successful. Evidence of autograft incorporation was found in all except 2 patients. The acetabular component failed and required revision in the latter 2 patients. The use of femoral head autograft in a select group of patients with symptomatic arthritis of hip and a failed prosthetic hip with severe bone loss in the contralateral side is a viable option. However, this technique should not be applied to acetabular reconstructions in which protected weight-bearing in the postoperative period may be necessary.

Adult↗
PubMed2005

Hip axis length as an independent risk factor for hip fracture independently of femural bone mineral density in Caucasian elderly Brazilian women.

Studies carried out in several countries and in different ethnic groups have suggested that the hip axis length (HAL) may be a risk factor for hip fractures. To evaluate if the HAL is an independent risk factor for hip fractures in elderly Caucasian Brazilian women, this study includes 112 participants sustaining proximal femur osteoporosis. Through HAL and bone mineral density (BMD) measurements, a statistical analysis using a multivaried regression curve was done. HAL was significantly longer in women sustaining a hip fracture than in the control group (99.24 +/- 5.9 mm vs. 96.95 +/- 5.6 mm, P < 0.05). After adjusting the standard HAL deviation for neck and trochanter BMD, OR was 1.43 (IC 95% 0.29 - 1.07; P < 0.08). When HAL was categorized for 97.8 mm (average HAL in all women), OR was 2.24 (IC 95% 1.04 - 4.84; P < 0.05). In conclusion, HAL may be associated with risk of hip fracture regardless of age, weight or BMD of elderly Brazilian Caucasian women.

Aged↗
PubMed2001

Hip-joint and abductor-muscle forces adequately represent in vivo loading of a cemented total hip reconstruction.

Using finite element analyses, we investigated which muscle groups acting around the hip-joint most prominently affected the load distributions in cemented total hip reconstructions with a bonded and debonded femoral stem. The purpose was to determine which muscle groups should be included in pre-clinical tests, predicting bone adaptation and mechanical failure of cemented reconstructions, ensuring an adequate representation of in vivo loading of the reconstruction. Loads were applied as occurring during heel-strike, mid-stance and push-off phases of gait. The stress/strain distributions within the reconstruction, produced by the hip-joint contact force, were compared to ones produced after sequentially including the abductors, the iliotibial tract and the adductors and vastii. Inclusion of the abductors had the most pronounced effect. They neutralized lateral bending of the reconstruction at heel-strike and increased medial bending at mid-stance and push-off. Bone strains and stem stresses were changed accordingly. Peak tensile cement stresses were reduced during all gait phases by amounts up to 50% around a bonded stem and 11% around a debonded one. Additional inclusion of the iliotibial tract, the adductors and the vastii produced relatively small effects during all gait phases. Their most prominent effect was a slight reduction of bone strains at the level of the stem tip during heel-strike. These results suggest that a loading configuration including the hip-joint contact force and the abductor forces can adequately reproduce in vivo loading of cemented total hip reconstructions in pre-clinical tests.

Biomechanical Phenomena↗
PubMed1995

Double-chevron subtrochanteric shortening derotational femoral osteotomy combined with total hip arthroplasty for the treatment of complete congenital dislocation of the hip in the adult. Preliminary report and description of a new surgical technique.

Total hip arthroplasty for the treatment of complete congenital dislocation of the hip in the adult has been associated with high rates of complications, including acetabular component loosening, femoral or sciatic nerve palsy, and prosthetic dislocation. Placement of the acetabular component in the true acetabulum has yielded the most durable results, but leads to significant limb lengthening, which is associated with sciatic and femoral nerve palsy. Femoral shortening with a transverse osteotomy tends to be torsionally unstable. Increased femoral anteversion complicates femoral component placement and, if not corrected, can lead to postoperative anterior instability and component dislocation. A new surgical technique that combines total hip arthroplasty with a femoral subtrochanteric shortening derotational double-chevron osteotomy in complete congenital hip dislocation using standard components is described. This procedure has been successfully performed in seven hips.

Aged↗
PubMed1996

Outcome of the contralateral hip following total hip arthroplasty for osteoarthritis.

One thousand one hundred and sixteen patients who underwent unilateral total hip arthroplasty osteoarthritis between 1970 and 1980 were examined for development, progression, and total hip arthroplasty in the contralateral joint. At the time of the original surgery, 452 patients were diagnosed with bilateral osteoarthritis and 664 had a normal contralateral hip. The probability of osteoarthritis progressing in the contralateral joint is 78.6% at 10 years, with the chance of arthroplasty being 53.8%. The probability of a hip diagnosed as normal developing osteoarthritis is 36.5% at 10 years, with an 8.3% chance of requiring total hip arthroplasty.

Adult↗
PubMed1996

Use of iliofemoral distraction in reducing high congenital dislocation of the hip before total hip arthroplasty.

The iliofemoral distraction with Wagner's apparatus was conducted in 20 adult patients with untreated unilateral congenital dislocation of the hip (Crowe group IV) before total hip arthroplasty. During the distraction period of 8 to 17 days, this technique had effectively reduced high dislocation of 4.5 cm (range, 3.5-5 cm). No pin-tract infection was encountered. Surgical difficulties in total hip arthroplasty for these patients were reduced. Potential problems, such as irreducibility, overshortening, nerve palsy, and displaced femoral fractures, were avoided. At an average follow-up period of 43 months (range, 25-63 months), all patients have excellent or good results, with an average Harris hip score of 94.3 (range, 84-100). Leg length was restored. The iliofemoral distraction is valuable prior to difficult total hip arthroplasty for high dislocation.

Adult↗
PubMed2003

Minimal invasive surgery for hip replacement: a new technique using the NILNAV hip system.

BACKGROUND: Minimal invasive surgical techniques are used for cruciate ligament reconstructions, unicondylar knee replacements and, more recently, for fixation of fractures. This is a report of the first instrumented technique for hip replacement using a 5-cm incision without the need for a navigation system or X-rays. METHODS: It uses the C.F.P stem (LINK) but is universal. It includes jigs for the osteotomy of the neck, a right-angled reamer and spacers (lollipops) to orientate the acetabular cup to the femoral stem. A case series of 14 patients using this new hip replacement technique (called NILNAV Hip System) is reported. RESULTS: The procedure was successfully performed on all seven patients, with reduced postoperative pain and stiffness, and increased quality of life and functional status. All patients were discharged on postoperative Days 1 and 2 with minimal pain and blood loss. CONCLUSIONS: This new minimal access total hip replacement technique was successfully performed on seven patients. There are several advantages of using this system compared with the more traditional techniques. Such a technique should help reduce morbidity and mortality rates for those patients undergoing a total hip replacement.

Adult↗
PubMed2001

Total hip arthroplasty for Crowe type IV developmental hip dysplasia: a long-term follow-up study.

A consecutive series of 118 total hip arthroplasties was performed for Crowe type IV developmental hip dysplasia in 89 patients. The mean age of the patients was 52 years. All procedures were carried out through a transtrochanteric approach by the same surgeon. In all cases, the acetabular component was placed at the level of the true acetabulum. The mean lengthening of the operated limb was 3.8 cm. The average follow-up of the whole series was 12.8 years. At the last follow-up evaluation, 29 patients (35 hips) had died or were lost to follow-up at a mean of 11 years. Sixty patients (83 hips) were still alive at a mean follow-up of 16 years. At the time of last follow-up, the mean Merle d'Aubigné hip score was 17.4 compared with 10.6 preoperatively. The survival rate, with revision for any reason as the endpoint, was 78% at 20-year follow-up.

Adult↗
PubMedDate not supplied

The c/b ratio in the radiological monitoring of the hip joint in congenital dislocation of the hip.

We report a method of monitoring hip joint development for congenital dislocation of the hip in children. The c/b ratio was measured on serial radiographs of 41 hips in 38 patients. The measurement was compared to c/b ratio obtained from normal hips. It was used to detect concentric reduction or its loss by migration of the femoral head during growth. The age at diagnosis ranged from 8 months to 10 years 6 months. The normal c/b ratio was found to change little with age. Deviation of the c/b ratio from normal in congenital dislocation of the hip resulted in a poor outcome and identified cases requiring further surgical intervention. This measurement of c/b ratio is simple and accurate, using easily determined points. The graphic display promotes critical analysis of situation and allows selection of cases at risk for treatment.

Child↗
PubMed2006

Effect of early postnatal body weight on femoral head ossification onset and hip osteoarthritis in a canine model of developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) is a well-known precipitator of hip osteoarthritis. An increase in body weight during the critical early postnatal growth period may alter joint contact, and thus alter hip development and influence joint health in adulthood. The objective of this study was to determine whether early postnatal body weight affected the course of hip development and the onset of osteoarthritis in a canine model of DDH. A longitudinal study, from birth to skeletal maturity, was conducted. Serial body weight, age at femoral head ossification onset, and femoral head coverage at 4 mo were measured. Presence and severity of degeneration at 8 mo were determined using necropsy and cartilage biochemistry. There was a negative association between birth weight and age at femoral head ossification onset; however, the association was likely due to skeletal maturity level rather than body weight per se. Lower birth weight subjects had greater femoral head coverage at 4 mo. Greater birth weight was associated with greater probability of moderate degenerative changes or macroscopic lesions at 8 mo. These results support the hypothesis that increased birth weight is sufficient to alter the course of hip development and result in measurable degenerative changes at adulthood.

Animals↗
PubMed2003

Change in Harris hip score in patients on the waiting list for total hip replacement.

AIM: To investigate the change in the Harris hip score in patients waiting for a total hip replacement, between the time of listing for operation and immediately pre-operatively. PATIENTS AND METHODS: For 167 consecutive patients listed for total hip replacement, the Harris hip score was taken both at time of listing for surgery and at pre-operative assessment 2 weeks prior to surgery. RESULTS: The median wait for operation in our unit was 330 days. The Harris score immediately preoperatively decreased compared with the initial score, with a mean decrease of 8.9 points. This result was highly statistically significant. Decrease in score also correlated with time on the waiting list. CONCLUSIONS: Patients requiring total hip replacement deteriorate while on the waiting list. Waiting times should be as short as possible to reduce unnecessary suffering.

Arthroplasty, Replacement, Hip↗
PubMed1996

Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty.

We describe three distinct types of congenital hip disease in adults. The first type is dysplasia, in which the femoral head is contained within the original true acetabulum. The second type is low dislocation, in which the femoral head articulates with a false acetabulum, the inferior lip of which contacts or overlaps the superior lip of the true acetabulum, giving the appearance of two overlapping acetabula. The third type is high dislocation, in which the femoral head has migrated superoposteriorly and there is no contact between the true and the false acetabulum. We describe and classify the acetabular abnormalities and deficiencies found with these three types. If the anterior, posterior, and superior aspects of the acetabular component cannot be covered during a total hip arthroplasty because of a deficient acetabulum in an adult who has congenital hip disease, we advocate and acetabuloplasty technique (which we have named a cotyloplasty) that involves medial advancement of the acetabular floor by the creation of a controlled comminuted fracture of its medial wall, autogenous bone-grafting, and the implantation of a small acetabular component with cement. This procedure was performed in sixty-six patients (eighty-six hips). Forty-nine of the hips had a high dislocation, thirty-one had a low dislocation, and six were dysplastic. Two to fifteen years (mean, seven years) after the operation, the clinical and radiographic results were satisfactory. Only two acetabular components needed to be revised for aseptic loosening, at 5.3 and 7.5 years postoperatively. Moreover, the cumulative success rate for the acetabular components was 100 percent at five years and 93.2 percent at ten years.

Acetabulum↗
PubMed1982

An objective examination for painful hip after total hip arthroplasty.

An objective method for evaluating the cause of pain in hip arthroplasty was investigated in patients with a radiolucent zone of less than 2 mm at the cement-bone interface or the cement-stem or socket interface. Eight patients with a McKee-Farrar total hip prosthesis followed up for an average of 102 months and 20 patients with a Charnley total hip prosthesis observed for an average of 43 months were studied. Different components of the implant materials, such as cement monomer, BaSO4, ceramic, acrylic cement, stainless steel and high-density polyethylene, (HDP) were exposed to normal plasma. Contact activation of plasma was found to occur for all materials, except for HDP, yielding plasma kallikrein. The induced prekallikrein activation was markedly reduced in vitro by Trasylol. There was a significant increase in plasma kallikrein activity in the patients with discomfort and/or pain without gross loosening compared with the patients with pain-free hip arthroplasties. Furthermore, statistically significant enhancement of the kallikrein activity was observed in plasma from the femoral vein at the site of operation compared with that from the cubital vein of the same subject. The enhanced plasma kallikrein activity in the patients gradually decreased, as did the clinical symptoms, when Trasylol was administered. It is concluded that measurement of plasma kallikrein activity may produce useful information about the process of total hip arthroplasty and provide an objective evaluation of pain.

Aprotinin↗
PubMed1996

Social function after cervical hip fracture. A comparison of hook-pins and total hip replacement in 47 patients.

47 patients with a cervical hip fracture Garden 3 or 4 and fully ambulatory before the fracture, were randomized to either fixation with Hansson hook-pins (24 patients, median age 79 years) or to a Charnley hip replacement (23 patients, median age 80 years). The patients were followed for 2 years. Social function was evaluated using a standard questionnaire. There were no postoperative deaths and no significant differences in hospital stay. 9/24 patients treated with hook-pins developed healing complications and 2 dislocations occurred in the THR group. After 1 and 2 years, fewer patients treated with hip replacement used outdoor walking aids; they were also more likely to do their own shopping. Hip replacement is a good choice when treating healthy older people with displaced cervical hip fractures, when primary mortality is expected to be low and the risk of healing complications after nailing is high.

Activities of Daily Living↗
PubMed1996

Total hip replacement in patients with hemophilia. 13 hips in 11 patients followed for 1-16 years.

During 1973-88, we performed 13 total hip replacements in 11 hemophilia patients, mean age 46 (25-65) years. During the operation, blood loss averaged 920 mL, and a mean of 120,000 units of factor VIII/IX were used. The mean duration of follow-up was 7 (1-16) years. 5 hips became loose within 6 years, and a further one after 13 years. 4 hips were revised, 2 of them due to infection in patients who were also seropositive for HIV. At the latest follow-up, 10 patients were alive. 6 had no hip pain and 7 could walk at least 1,000 meters at a time. Although these results are inferior to those obtained in arthrosis, total hip replacement should be considered in hemophiliac patients.

Adult↗