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At least 433 records · Page 24Linked to original sources
PubMed1985

The influence of total hip replacement on hip pain and the use of analgesics.

The influence of total hip replacement (THR) on pain and use of analgesics was evaluated in 511 patients with McKee-Farrar and Brunswik prostheses. The mean age of the patients was 63.8 years and the mean follow-up time 4.2 years. The average grade of pain decreased from 1.8 to 4.9 as evaluated according to Charnley. The proportion of regular users of all analgesics decreased from 75% to 17% (P less than 0.001). Indomethacin was the most common preoperative drug and the proportion of its regular use decreased from 47 to 12% (P less than 0.001). The preoperative association which existed between the grade of pain and the regular drug users in each pain grade decreased more than expected by the preoperative figures. Postoperatively those with previous hip operations, McKee-Farrar prosthesis, one hip replaced, reapplications and removal of the prosthesis gave inferior results with respect to pain than those without previous surgery, with Brunswik prosthesis, both hips replaced and with the original prosthesis in situ. In addition to previous THR operations, type of the hip prosthesis, bilateral or unilateral surgery, primary or secondary coxarthrosis and reapplication of the prosthesis influenced the use of drugs. THR, however, brought a marked drop in the use of analgesics and this effect should be taken into account when assessing the costs and benefits of THR.

Adrenal Cortex Hormones↗
PubMed2005

Total hip arthroplasty through a minimal posterior approach using imageless computer-assisted hip navigation.

With decreased exposure in a minimal posterior hip incision, navigation with computer assistance provides an alternative method to accurately place the components. This study compares the results of a series of 82 navigated total hips to a retrospective cohort of 50 hips done with conventional instruments. The surgical incision split the gluteus maximus but did not extend distally into the fascia. The goal of cup placement was 40 degrees to 45 degrees of abduction (ABD) and 17 degrees to 23 degrees of flexion (FLX). Postoperative radiographs were digitized and analyzed. In the study group, 82 hips were done with computer assistance and compared with 50 done with conventional methods (manual) through the same incision. Radiographic analysis showed that there were significantly fewer cases inside the desired range of ABD and FLX in the manual group (6%) compared with the navigation group (30%), P = .001, with significant differences in the variances of ABD and FLX (P = .011 and .028). Improved accuracy of cup placement was found with increased experience in the use of navigation by the surgeon over the time of the series. The use of a computer-assisted surgery navigation system with a minimal posterior incision for a total hip arthroplasty results in significantly more reproducible acetabular component placement.

Adult↗
PubMed2002

Alumina-alumina artificial hip joints. Part II: characterisation of the wear debris from in vitro hip joint simulations.

Until recently it was not possible to reproduce clinically relevant wear rates and wear patterns in in vitro hip joint simulators for alumina ceramic-on-ceramic hip prostheses. The introduction of microseparation of the prosthesis components into in vitro wear simulations produced clinically relevant wear rates and wear patterns for the first time. The aim of this study was to characterise the wear particles generated from standard simulator testing and microseparation simulator testing of hot isostatically pressed (HIPed) and non-HIPed alumina ceramic-on-ceramic hip prostheses, and compare these particles to those generated in vivo. Standard simulation conditions produced wear rates of approximately 0.1 mm3 per million cycles for both material types. No change in surface roughness was detected and very few wear features were observed. In contrast, when microseparation was introduced into the wear simulation, wear rates of between 1.24 (HIPed) and 1.74 mm3 per million cycles (non-HIPed) were produced. Surface roughness increased and a wear stripe often observed clinically on retrieved femoral heads was also reproduced. Under standard simulation conditions only nanometre-sized wear particles (2-27.5 nm) were observed by TEM, and it was thought likely that these particles resulted from relief polishing of the alumina ceramic. However, when microseparation of the prosthesis components was introduced into the simulation, a bi-modal distribution of particle sizes was observed. The nanometre-sized particles produced by relief polishing were present (1-35nm). however, larger micrometre-sized particles were also observed by both transmission electron microscopy (TEM) (0.021 microm) and scanning electron microscopy (SEM) (0.05-->10 microm). These larger particles were thought to originate from the wear stripe and were produced by trans-granular fracture of the alumina ceramic. In Part I of this study, alumina ceramic wear particles were isolated from the periprosthetic tissues from around Mittelmeier ceramic-on-ceramic hip prostheses. Characterisation of the particles by TEM and SEM revealed a bi-modal size distribution. SEM analysis revealed particles in the 0.05-3.2 microm size range. and TEM revealed particles in the 5-90 nm size range, indicating that microseparation of the prosthesis components may be a common event in vivo. This study (Part II) has revealed that the introduction of microseparation of the prosthesis components during the swing phase of the wear simulation reproduced clinically relevant wear rates, wear patterns and wear particles in in vitro hip joint simulators.

Aluminum Oxide↗
PubMed1990

The use of a hip score for evaluation of the results of total hip arthroplasty.

Both the Harris and the Charnley hip evaluation forms were applied to 191 ingrowth-type total hip arthroplasties in an attempt to determine the effectiveness of the hip score as an indicator of success following arthroplasty. The Harris form demonstrated significantly lower pain scores than the Charnley form and, consequently, failed patients more often due to pain. However, it is important to note that 32% of the hips that failed due to pain on the Harris form did not fail due to total score. This inconsistency prompts the authors to state that when using a hip form to evaluate the performance of a prosthesis, especially one of the ingrowth type, it is important to consider not only the average total score but also the percentage of patients still experiencing significant pain.

Disability Evaluation↗
PubMed1986

Conversion total hip replacement. Review of 140 hips with greater than 6-year follow-up study.

The authors compared 140 conversion with 433 primary total hip arthroplasties with a 40-month minimum follow-up period. All replacements were performed with a transtrochanteric technique. No conversion total hip arthroplasty had prior cementation. Pain was the indication for surgery. The average number of prior operations was 1.3 and the average number of months to total hip arthroplasty was 65.4. The patient characteristics for the two groups were similar. The overall results were uniformly good to excellent (94% or better) at greater than 6-year mean follow-up in both groups. The authors review important differences between the two groups. None of the differences are statistically significant. The overall results of conversion total hip arthroplasty were good to excellent, and the presence of a preoperative infection did not significantly alter the clinical results. The absence of prior bone cement in conversion total hip arthroplasty is proposed to explain these findings.

Hip Prosthesis↗
PubMed2003

The mid-point of passive hip rotation range is an indicator of hip rotation in gait in cerebral palsy.

This study investigated the strength of any linear relationship between femoral anteversion and passive hip rotations, with rotation of the limb during gait. The data of 29 subjects (38 legs) with cerebral palsy (CP) were reviewed. Passive examination data were correlated with hip rotations during the whole gait cycle, and in stance only. Hip rotation in gait correlated significantly with passive external rotation (r=0.51-0.54), femoral anteversion (r=0.43-0.47), and passive internal rotation (r=0.36-0.41). The mid-point of passive hip rotation range correlated best with hip rotation in the stance phase of gait (r=0.57-0.58).

Adolescent↗
PubMed1999

The 'Entlastungsgang'. A hip unloading gait as a new conservative therapy for hip pain in the adult.

'Entlastungsgang' is a gait modification aiming to unload the hip joint by producing a modified Duchenne-limp (straight spinal column, additional lifting of the pelvis on the side of the swinging leg and a consecutive side shift of the pelvis) and a wide stance gait. Sixteen patients suffering from hip pain caused mainly by hip dysplasia were investigated. They received daily gait training for 12 h combined with intensive physical therapy as in-patients for 3-4 weeks. The external muscle torque acting on the hip joint was determined by 3D-gait analysis before, during and after the gait training. We found a reduction of the muscle torque after gait training to 77.2% of the initial value. At an average follow up of 12 months we found a persisting reduction of the muscle torque to 87. 0% at spontaneous gait that was further reduced to 81.3% of the initial value. The hip score for two components of the Merle d'Aubigne and Postel score for pain and walking was significantly improved from 7.4 to 10.8 points.

Adult↗
PubMed2004

Femoral anteversion influences vastus medialis and gluteus medius EMG amplitude: composite hip abductor EMG amplitude ratios during isometric combined hip abduction-external rotation.

This prospective study evaluated differences in vastus medialis (VM) and gluteus medius (GM) EMG amplitude:composite hip abductor (gluteus maximus, gluteus medius, tensor fascia lata) EMG amplitude ratios among subjects with low or high relative femoral anteversion. Data were collected during the performance of a non-weight bearing, non-sagittal plane maximal volitional effort isometric combined hip abduction-external rotation maneuver. Eighteen nonimpaired athletically active females participated in this surface EMG study. Medial hip rotation (relative femoral anteversion estimate) was measured with a handheld goniometer. Subjects were grouped by medial hip rotation displacement (group 1 < or = 42 degrees =36.1+/-7 degrees and group 2 > 42 degrees =52.7+/-7 degrees ) for statistical analysis (Mann Whitney U-tests, p < 0.05). Group 2 had decreased VM (42+/-23% vs. 69+/-30%, U=19, p=0.034) and GM (62+/-25% vs. 96+/-39%, U=19, p=0.034) normalized mean peak EMG amplitude:composite mean peak hip abductor EMG amplitude ratios compared to group 1. Decreased normalized VM (-27%) and GM (-34%) EMG amplitudes among subjects with increased relative femoral anteversion suggest reduced dynamic frontal and transverse plane femoral control from these muscles, possibly contributing to the increased incidence of non-contact knee injury observed among athletic females.

Adult↗
PubMed1998

The radiographic trabecular pattern of hips in patients with hip fractures and in elderly control subjects.

Due to the increasing number of osteoporotic fractures of hip, spine, and wrist there is a growing need for methods to track down the subjects with inferior bone structure and to monitor the effects of therapeutic measures. This study aims at a noninvasive diagnostic tool, deriving architectural properties of trabecular bone from in vivo measurements on plane radiographic films. Pelvic radiographs of the nonfractured hips of 81 patients with hip fractures and of the right hips of 74 controls were studied. The regions of interest, 2 x 2 cm2, located in the femoral neck, were sampled and digitized with a video camera connected to an image analysis system. Several geometrical and directional measurements were made. The measurements were evaluated by statistical comparison with fracture risk, gender, and Singh index. By discriminant analysis, type of fracture, as well as gender and Singh index could be predicted correctly for 58% of the subjects, whereas guessing would be correct in only 8%. It was found that the geometrical parameters discriminate between hips of controls and patients. With respect to the directional measurements associations were found with gender and Singh index. Although the new parameters assess fracture risk less accurately than bone density measurements, some parameters suggest by their behavior that they are relevant with respect to femoral bone architecture and its mechanical behavior. Although interpretation of the measurements in histological concepts requires methods that have been reported in literature only recently, it is concluded that digital analysis of the radiographic trabecular pattern is an interesting option to increase the diagnostic yield of plane film radiographs and to study the structure of bone in vivo.

Age Factors↗
PubMed2000

Are the findings in the Swedish National Total Hip Arthroplasty Register valid? A comparison between the Swedish National Total Hip Arthroplasty Register, the National Discharge Register, and the National Death Register.

The Swedish National Total Hip Arthroplasty (THA) Register was initiated in 1979, and it is one of the oldest quality registers in the world. The register covers all hospitals in Sweden, and today it contains > 205,000 hip arthroplasties. The failure endpoint definition in the register is revision. There is no information about quality of life and mortality. The aim of this study was to validate the results presented by the Swedish THA register by comparison with the Discharge register (the Swedish National Board of Health and Welfare) and to study mortality after hip arthroplasties. All hip arthroplasties from the Discharge register, performed in 1986 and thereafter, were compared with the Swedish THA register. Epidemiologic parameters, including mortality, were documented from the Swedish Death register. The mortality for primary THAs for men was 1% higher and for women 6% higher when compared with an age-matched and sex-matched cohort. For revision, the numbers were 7% and 9% higher. The risk for death compared with an age-matched and sex-matched population was lower for patients with osteoarthrosis treated with hip arthroplasty. The results with revision as failure endpoint showed that the Swedish THA register is reliable. The register includes >95% of the primary and revision THAs performed in Sweden between 1986 and 1995.

Aged↗
PubMedDate not supplied

[The Tübingen hip flexion splint in the treatment of hip dysplasia].

The intrauterine hip position coincides with the so called squatting position with more than 90 degrees of flexion. This position is considered the best prerequisite for physiological development of the infant hips. In this position, pressure is equally distributed and there is no tension on the capsular blood vessels. A hip flexion splint is described which in a simple way provides for a reliable fixation of a newborn's hip in a flexion angle of more than 90 degrees an also for controlled abduction. Our splint is indicated in hip dysplasia. The paper illustrates the application on this inexpensive splint and its day-to-day care. Also we report on third party experience. The paper is summarized in the initial poster presentation.

Follow-Up Studies↗
PubMedDate not supplied

[Salter's pelvic osteotomy in the treatment of congenital hip dislocation and hip dysplasia with special reference to pelvic tilt].

On the basis of 63 Salter pelvic osteotomies which were performed in 57 patients with congenital dislocation and subluxation of the hip between 1970 and 1986 at the Orthopaedic University Clinic of Vienna, we tried to work out the reasons for the rate of failures of 29% in our material. The mean age at operation was 4.1 years (1.5-18), that at follow up 15.7 years (4.6-28). We based our assessments on the clinical and radiological criteria of the Commission for the Study of Hip Dysplasia of the German Society of Orthopaedics and Traumatology. The number of failures at follow up (hip value III + IV) increased from 25%, if the operation was done before the age of four years, to 41%, if it was performed at a later age. In the latter group we were not able to observe any spontaneous improvement, which was typical for the younger age group. A moderately pathologic hip dysplasia (hip value III) could be improved to a normal value at follow up in 87%, an extremely pathologic one just in 50% of the cases. In just some of the patients we found postoperatively a tilt of the distal pelvic fragment, which could be registered by the oval shape of the foramen obturatum. Above all in young children a pelvic tilt was rare because of the elasticity of the triradiate cartilage. Out of 37 evaluable cases a tilt of the distal pelvic fragment by the operation could be verified in only 12 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Physical activity and hip fracture: a population-based case-control study. Swedish Hip Fracture Study Group.

BACKGROUND: A growing body of literature suggests that physical activity may be a protective factor against hip fracture. METHODS: To study the association between hip fracture risk and recreational physical activity at various ages, changes in activity during adult life, occupational physical activity and how risks vary by adult weight change, we performed a population-based case-control study among postmenopausal women aged 50-81 years residing in six counties in Sweden in 1993-1995. The analysis consisted of 1327 women with hip fracture and 3262 randomly selected controls. Information on leisure physical activity before age 18, at 18-30 years and during recent years was based on a questionnaire. Data on occupational physical activity were collected through an independent classification of job titles obtained from record linkage with census data from 1960, 1970 and 1980. RESULTS: There was a protective effect of recent leisure physical activity. Compared to women who reported no leisure activity, the odds ratios (OR) were 0.79 (95% CI: 0.62-1.00), 0.67 (95% CI: 0.54-0.84) and 0.48 (95% CI: 0.39-0.60) for women who exercised <1 h per week, 1-2 h per week, and 3+ h per week, respectively. These decreased OR were more pronounced in women who had lost weight after 18 years of age than in those who had gained weight. Women with high physical activity at both 18-30 years and during recent years did not have a stronger protection than those with isolated high activity late in life, after accounting for recent activity. Occupational physical activity was not associated with hip fracture risk in this study. CONCLUSIONS: Recent physical activity is protective against hip fracture. The protective effect is most pronounced in women who had lost weight after age 18.

Aged↗
PubMed2004

Use of the talon hip compression screw in intertrochanteric fractures of the hip.

A retrospective analysis of a compression hip screw with four reversibly deployable talons was done. Fifty-four patients had sufficient radiographs to be included in this analysis. One-year mortality was 17% and increased to 41% by 2 years. No lag screws cut out, and postoperative slide was reduced compared with that in many published series. Three patients had revision of a failed alternate-type hip pin with the Talon hip compression screw. Previous studies showed the talons provide the definitive difference in allowing enhanced compression at the time of surgery, preventing cut-out by enhanced rotational stability, and allowing immediate postoperative weightbearing without excessive limb shortening. The failure mode of the Talon compression hip screw seems to be side-plate loosening rather than varus deformity and lag screw cut-out. The Talon compression hip screw especially is effective with weak, osteoporotic bone and in unstable, three-part and four-part fractures. A previous study showed that Talon deployment notably improved interfragment compression and torsional strength, and that engagement or penetration into or through the cortical bone at the base of the femoral head-neck junction in the inferior lag screw position was the critical technical step to maximize the talon lag screw purchase.

Adolescent↗
PubMed1984

Congenital dysplasia of the hip: the lax (subluxatable) newborn hip.

During a 4-year period, 15,149 newborns were examined for hip abnormalities. Ninety-two infants (0.61%) were found to have subluxatable (lax, but not dislocatable) hips. The profile of this group was similar to patients with dislocated hips, with an increased frequency of females, breech presentations, left-sided involvement, and associated postural deformities. A significant number showed acetabular dysplasia or persistent hip laxity despite treatment with an abduction brace. We concluded that the newborn subluxatable hip arises from the same antecedents as frank dislocation, is not always benign, and is best managed if detected and treated at birth.

Female↗
PubMedDate not supplied

Stability of the hip joint after reduction of late-diagnosed congenital dislocation of the hip.

Nine children with late-diagnosed congenital dislocation of the hip underwent ultrasonography for determination of the influence of hip flexion on hip stability after reduction. No medication was used, and the investigation was performed in existing abduction splints during active movements of the leg. Redislocation of the joint was related to the minimal degree of flexion (120, 110, 100, or 90 degrees) permitted by the splint. All hips redislocated when flexion was less than 100 degrees. Five joints need 100 degrees and two 110 degrees of flexion for prevention of redislocation, and two hips required as much as 120 degrees.

Hip Dislocation, Congenital↗
PubMed1999

Measurement of patient perceptions of pain and disability in relation to total hip replacement: the place of the Oxford hip score in mixed methods.

OBJECTIVES: To describe the practical difficulties experienced by patients when completing the Oxford hip score, and to highlight the need to reconsider aspects of its structure and conceptual base. DESIGN: Qualitative study incorporating the Oxford hip score in semi-structured interviews with patients before and four months after their operation. SETTING: Two hospitals in the North of England. SUBJECTS: Osteoarthritic patients undergoing primary elective total hip replacement. RESULTS: Use of the Oxford hip score provided quantitative data on disability in the sample, particularly about pain and immobility. It also facilitated the collection of qualitative data, serving as a useful starting point for interviews and as a prompt for indepth discussion. Concerns about the clarity, coverage, and content validity of the score were identified, however, raising questions about the measure's conceptual base. CONCLUSION: The Oxford hip score was found to be a useful precursor to the semi-structured interviews. However, deficiencies in instruction and lack of clarity in purpose have implications for its ongoing development and future application, both in this type of study and other, more general, contexts.

Adult↗
PubMed2006

Removal of acetabular bone in resurfacing arthroplasty of the hip: a comparison with hybrid total hip arthroplasty.

Resurfacing arthroplasty of the hip is being performed more frequently in the United Kingdom. The majority of these patients are younger than 55 years of age, and in this group the key benefits include conservation of femoral bone stock and the potential reduction in the rate of dislocation afforded by the larger resurfacing head. Early aseptic loosening is well recognised in patients younger than 55 years of age, and proponents of resurfacing believe that the improved wear characteristics of the metal-on-metal bearing may improve the long-term survival of this implant. There has been some concern, however, that resurfacing may not be conservative of acetabular bone. We compared a series of 33 consecutive patients who had a hybrid total hip arthroplasty with an uncemented acetabular component and a cemented femoral implant, with 35 patients undergoing a Birmingham hip resurfacing arthroplasty. We compared the diameter of the implanted acetabulum in both groups and, because they were not directly comparable, we corrected for patient size by measuring the diameter of the contralateral femoral head. The data were analysed using unpaired t-tests and analysis of covariance. There was a significantly larger acetabulum in the Birmingham arthroplasty group (mean diameter 56.6 mm vs 52.0 mm; p < 0.001). However, this group had a significantly larger femoral head diameter on the contralateral side (p = 0.03). Analysis of covariance revealed a significant difference between the mean size of the acetabular component implanted in the two operations. The greatest difference in the size of acetabulum was in those patients with a larger diameter of the femoral head. This study shows that more bone is removed from the acetabulum in hip resurfacing than during hybrid total hip arthroplasty, a difference which is most marked in larger patients.

Acetabulum↗