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At least 451 records · Page 25Linked to original sources
PubMed2006

Age trends in femur stresses from a simulated fall on the hip among men and women: evidence of homeostatic adaptation underlying the decline in hip BMD.

UNLABELLED: Age trends in proximal femur stresses were evaluated by simulating a fall on the greater trochanter using femur geometry from hip DXA scans of 5334 white men and women in the NHANES III survey. Expansion of femur outer diameter seems to counter net bone loss so that stresses remain similar across age groups, but stresses are higher in older women than in older men. INTRODUCTION: The age decline in hip BMD is caused by both bone loss and expansion of outer diameter that increases the region size over which mass is measured in a DXA scan. Because expansion has an opposing effect on structural strength, it may be a homeostatic adaptation to net bone loss to ensure that load stresses are kept within a narrow range. MATERIALS AND METHODS: Age trends in femur stresses were evaluated with an engineering beam simulation of a fall on the greater trochanter. Hip geometry was extracted from hip DXA scans using the Hip Structure Analysis (HSA) software on 2613 non-Hispanic white men and 2721 women from the third National Health and Nutrition Examination Survey (NHANES III). Using body weight as load, stresses were computed on the inferior-medial and superior-lateral femur neck at its narrowest point and the medial and lateral shaft 2 cm distal to the midpoint of the lesser trochanter. Stresses and the underlying geometries in men and women >50 years oaf age were compared with those 20-49 years of age. RESULTS: Compared with men <50 years of age, stresses in older men were 6% lower on both surfaces of the shaft, 4% lower on the inferior-medial neck, and not different on the superior-lateral neck. In women >50 years of age, stresses on the proximal shaft and inferior-medial neck remained within 3% of young values but were 13% greater on the superior-lateral neck. Neck stresses in young women were lower on the superior-lateral than the inferior-medial neck, but lateral stress increased to the level on the medial surface in older women. Stresses were higher in women than in men, with a greater gender difference in those >50 years of age. CONCLUSIONS: We conclude that femur expansion has a homeostatic effect in men and women that opposes bone loss so that stresses change little with age. Because expansion preserves stresses with progressively less bone mass, the process may reduce structural stability in the femoral neck under fall conditions, especially in the elderly female.

Accidental Falls↗
PubMed2000

Clinical practice guideline: early detection of developmental dysplasia of the hip. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip. American Academy of Pediatrics.

Developmental dysplasia of the hip is the preferred term to describe the condition in which the femoral head has an abnormal relationship to the acetabulum. Developmental dysplasia of the hip includes frank dislocation (luxation), partial dislocation (subluxation), instability wherein the femoral head comes in and out of the socket, and an array of radiographic abnormalities that reflect inadequate formation of the acetabulum. Because many of these findings may not be present at birth, the term developmental more accurately reflects the biologic features than does the term congenital. The disorder is uncommon. The earlier a dislocated hip is detected, the simpler and more effective is the treatment. Despite newborn screening programs, dislocated hips continue to be diagnosed later in infancy and childhood,(1-11) in some instances delaying appropriate therapy and leading to a substantial number of malpractice claims. The objective of this guideline is to reduce the number of dislocated hips detected later in infancy and childhood. The target audience is the primary care provider. The target patient is the healthy newborn up to 18 months of age, excluding those with neuromuscular disorders, myelodysplasia, or arthrogryposis.

Algorithms↗
PubMed2005

Comparison of arthroscopic and radiographic abnormalities in the hip joints of juvenile dogs with hip dysplasia.

OBJECTIVE: To compare radiographic and arthroscopic abnormalities in juvenile dogs with clinically apparent hip dysplasia. DESIGN: Case series. ANIMALS: 52 dogs (70 hip joints) with clinical signs of hip dysplasia scheduled to undergo triple pelvic osteotomy. PROCEDURE: A ventrodorsal radiographic projection of the pelvis was evaluated by a radiologist unaware of clinical and arthroscopic findings, and radiographic osteoarthritic abnormalities were judged and scored as absent (0), mild (1), moderate (2), or severe (3). Arthroscopy was performed by a surgeon unaware of clinical and radiographic findings, and arthroscopic abnormalities were graded from 0 (normal) to 5 (exposed, eburnated subchondral bone). RESULTS: In 30 of the 70 (43%) hip joints, no radiographic osteoarthritic abnormalities were seen. Severe, full-thickness articular cartilage lesions (grade 4) of the femoral head or acetabulum were seen arthroscopically in 14 (20%) joints. Lesions > or = grade 2 were seen in 60 (86%) joints. Partial tearing of the ligament of the femoral head was present in 57 (81%) joints, and complete rupture was seen in 5 (7%). Radiographic abnormalities were seen in 13 of the 14 (93%; 95% confidence interval, 66% to 99.8%) joints with grade 4 arthroscopic abnormalities but in only 23 of the 46 (50%; 95% confidence interval, 35% to 65%) joints with grade 2 or 3 arthroscopic abnormalities. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that radiography is not a sensitive method for identifying moderate cartilage lesions in juvenile dogs with hip dysplasia. If moderate cartilage lesions are an important prognostic indicator for the success of triple pelvic osteotomy, then methods other than radiography should be used to detect these lesions.

Animals↗
PubMed1990

Universal total hip replacement with focus on the acetabular component and the hybrid hip.

One hundred sixty-one porous-coated Universal (Biomet Inc, Warsaw, IN) total hip arthroplasties were performed and studied preoperatively between July 1986 and June 1989. The study included 59 men (38 at 1-year follow-up; 21 at 2-year follow-up) and 91 women (60 at 1-year follow-up; 31 at 2-year follow-up). The average age was 62 years at 12-month follow-up and 64.7 years at 24-month follow-up (range 28 to 90 years). Three groups of patients with components were evaluated both clinically and radiographically: uncemented femoral and acetabular components (group 1); cemented femoral stems and uncemented acetabular components, ie, hybrid total hip arthroplasties (group 2); and revision total hip replacement arthroplasties (group 3). Clinical results for all groups showed Harris hip scores of 87 at 1-year follow-up and 89 at 2-year follow-up. Moderate to no limp occurred in 93% of patients at 1-year follow-up and 95% at 2-year follow-up. No ambulatory aids were used by 43% of patients at 1-year follow-up or 47% at 2-year follow-up. Both walking distance and endurance improved over time. Anthropometric analysis showed no progressive lucencies around the femoral or acetabular component in either group. A Kaplan-Meier survivorship analysis could not be used, because there was only one failure. This eliminated a comparison group for those lost to follow-up. Early clinical and radiographic results have been encouraging; however, long-term analysis is needed to accurately assess the success of this total hip arthroplasty system.

Acetabulum↗
PubMed2002

The influence of the biomechanical parameters of the hip on the outcome of treatment of hips subject to avascular necrosis of the femoral head.

We were interested in whether or not the biomechanical status of the hip influences the course of avascular necrosis of the femoral head. To investigate this, we used a computer aided system based on a three dimensional mathematical model for determining the stress distribution in the hip joint from standard anteroposterior rentgenographs (X-ray images) of both hips and pelvis. Based on the results of our study, we suggest that the biomechanical parameters of the hip play an important role in the outcome of treatment of hips affected by avascular necrosis of the femoral head.

Biomechanical Phenomena↗
PubMedDate not supplied

Eight-year prospective targeted ultrasound screening program for instability and at-risk hip joints in developmental dysplasia of the hip.

The use of targeted ultrasound screening for at-risk hips to reduce the rate of surgery in developmental dysplasia of the hip is unproven. A prospective trial was undertaken in an attempt to clarify this matter. This study was undertaken between May 1992 and April 2000. There were 28,676 live births. Unstable and at-risk hips were routinely targeted for ultrasound examination. One thousand eight hundred six infants underwent ultrasound examination (6.3% of the birth population). Twenty-five children (18 with dislocations, 7 with dysplasia) required surgical intervention in the form of open reduction of the hip or pelvic or femoral osteotomy (0.87 per 1,000 births for dysplasia, 0.63 per 1,000 births for dislocation). Targeted ultrasound screening does not reduce the overall rate of surgery compared with the best conventional clinical screening programs. The development of a national targeted ultrasound screening program for at-risk hips cannot be justified on a cost or result basis.

Breech Presentation↗
PubMed2002

Primary total hip arthroplasty without the use of bone cement: a 10-year follow-up of 157 hips.

BACKGROUND: The cementless fixation technique in total hip arthroplasty (THA) was developed to solve clinical problems such as aseptic loosening and osteolysis which were thought to be associated with the use of bone cement. This retrospective study reports our mid-term results with cementless THA. METHODS: A series of 173 consecutive, unselected cementless THA procedures using the Omnifit prosthesis was performed by a single surgeon. Sixteen hips were excluded from the study because of insufficient follow-up evaluation. One hundred and fifty-seven THAs with an average follow-up period of 10.2 (range, 5-12) years were retrospectively reviewed. RESULTS: The overall revision rate was 7.0%. Ninety-five percent of unrevised hips achieved a Merle D'Aubigne hip score of 16 points or above. Radiographically, bone ingrowth occurred in all unrevised cups, and in 95% of unrevised stems. Osteolytic lesions, seen on 28.1% of femora and 8.9% of pelvises, appeared at an average of 3.8 years postoperatively. Femoral osteolytic lesions were confined to the proximal Gruen zones 1 and 7. The mean annual polyethylene wear rate was 0.15 mm. Approximately 1/3 of the hips were noted to have excessive wear. CONCLUSION: These results suggest that cementless Omnifit THA provides stable fixation for as long as 12 years after implantation. Of significant concern is the high incidence of excessive polyethylene wear and associated osteolysis. Our experience also indicates that a femoral stem with a circumferential porous coating in the proximal region can protect the femur from distal osteolysis.

Adult↗
PubMed2005

[Prevention of hip fractures using hip protectors].

Based on the results of 13 randomized controlled trials, programs for the use of hip protectors in institutionalized elderly people with particularly high risks of hip fractures seem to decrease the incidence of hip fractures. On the other hand, there is little indication for the use of hip protectors by elderly people dwelling independently in their own homes. Compliance greatly influences the effect of hip protectors, and continues to be serious problem.

Aged↗
PubMed2006

Soft-tissue balance evaluation system for total hip arthroplasty by intraoperative contact pressure measurement at the hip joint.

We developed a system for measurement of contact pressure at the hip joint surfaces that enables checking of the artificial hip joint condition during surgery. First, we constructed the pressure sensor that forms the artificial joint. We installed eight small pressure sensors to the spherical head component, a part of the ball-socket joint. Next, we developed software for recording and visualizing the detected pressures that were recorded every 1 ms. The pressure distribution was displayed with the 3D computer graphics in real-time. The system enabled intuitive recognition of pressure direction 3-dimensions. Next, using the system, we conducted measurements during total hip arthroplasty. Although it requires some improvements in its measurement accuracy, the system allows real-time acquisition of information on the artificial hip joint in real-time. Further improvements of the calibration method should enable more accurate measurements. As a complete system, it will be a useful tool for selecting an appropriate implant that fits a patient's hip joint or for estimating the risk of complications after surgery.

Arthroplasty, Replacement, Hip↗
PubMed2006

Fate of the normal uninvolved hip opposite closed reduction of unilateral developmental dislocation of the hip.

The purpose of this study was to determine the incidence of avascular necrosis and acetabular dysplasia in the normal uninvolved contralateral hip opposite a unilateral dislocated hip. Thirty-five children with unilateral developmental dislocation of the hip underwent closed reduction. Medical records were reviewed for gender, side, age at reduction, and presence of the ossific nucleus at reduction. Avascular necrosis was reported as present if there was proximal femoral deformity on postoperative radiographs. Acetabular dysplasia was noted as present based on reported values. The mean age at reduction was 10 months. The mean age at time of follow-up radiograph was 101 months. There was no evidence of avascular necrosis in any of the uninvolved hips. Acetabular dysplasia was present in 22 (63%) uninvolved hips.

Acetabulum↗
PubMed2006

[Do hip protectors decrease the risk of hip fracture in elderly?].

Efforts aimed at preventing hip fractures include lifestyle advice for high-risk elderly, interventions to reduce the risk of falls and medication for osteoporosis. Alternative approach is the use of hip protectors. Hip protectors have pads designed to cover the greater trochanter and attenuate or disperse the force of a fall sufficiently to prevent a hip fracture. There are 14 randomized controlled trials (RCTs) included in the Cochrane systematic review until 2005. All RCTs were classified into three groups by the type of randomization; cluster randomized in institutions, individually randomized in institutions and individually randomized in community. There is little evidence to support the use of hip protectors outside the nursing home setting. Further research is required, primarily to produce a device that provide higher compliance, and which will then need to be tested in another RCT.

Aged↗
PubMed1979

[Spasm of the adductor muscles, pre-dislocation and dislocations of the hip joints in children and adolescents with cerebral palsy. Clinical observations on aetiology, pathogenesis, therapy and rehabilitation. Part I: The effect of open myotenotomy of the gracilis muscle and of the long and short adductor muscles in connection with total extrapelvine resection of the obturator nerve, on the hip joints and static function (author's transl)].

Spasm and contraction of the adductor muscles involve, on the one hand, danger in respect of the development of a dislocation of the hip, and are a serious impediment to a walking ability on the other. Hence, surgery is often necessary. The article reports on the results of consequent weakening of the adductor muscles as a result of open myotenotomy in association with complete extrapelvine resection of the obturator nerve. 27 patients were subjected to surgery--in most cases bilaterally--at an age between 2 years and 5 months and 18 years, with a follow-up period of up to 15 years. The study does not include patients with spastic dislocation of the hip in whom this method was applied on the non-dislocated side and on the dislocated side in combination with iliopsoas tenotomy. This method makes it possible to achieve regression of existing defective positions of the hip joints. In a few cases, the valgus position of the neck of the femur was corrected to some extent. In two patients it was not possible to prevent the progress of a developing dislocation of the hip. These results show that, whereas the adductor muscles represent an essential factor for the occurrence of a spastic dislocation of the hip, other forces are most probably also involved. In the majority of cases, results were favourable in respect of the static function, although in some cases the success became evident after several years only, especially in mentally retarded patients and in apathetic individuals. Important for therapeutic success is the follow-up. The principles of its therapy are thoroughly discussed. Surgery is indicated only in special cases. Indications must be observed very strictly, since the risk of excessive weakening of the adductor muscles should not be underestimated.

Adolescent↗
PubMed1989

[Management of hip fractures using a dynamic hip screw].

Authors describe the history of the dynamic hip screw and analyse the hip fracture. The operative technique of the DHS is described in details. In an analysis of the material of the Wilhelminenspital it is stressed that in the last years the DHS became dominant in the treatment of hip fractures. The treatment of four different types of fractures with DHS is demonstrated. The method is compared with other methods suitable for the treatment of hip fractures and it is stated that the less complications can be expected from the use of the DHS. On the basis of this comparison it is shown that the DHS is worthy to occupy a decisive place in the treatment of hip fractures.

Aged↗
PubMed1983

[Development of the S-form hip brace of Wakayama Medical College type for osteoarthritis of the hip].

In order to improve the therapeutic results of conservative treatment for coxarthrosis and to start functional training soon after surgery, the S-form hip brace of Wakayama Medical College type has been developed with due regard to the instability of the hip joint which is related to the origin of coxarthrosis and to biomechanics of the hip joint. Functional investigation was made by electromyography, etc. Even healthy people tend to develop gradual lack of stability at the hip joint with aging and the tendency is more pronounced in secondary coxarthrosis. This brace has been designed to reinforce such an unstable hip joint both mechanically and functionally, to permit flexion, extension and abduction, to correct the inadequate position of the limb such as adduction, both internal and external rotation contractures, to prevent up- and outward movement of the femoral head and to keep it in a more centripetal position. This brace had been applied to 1,678 cases in 17 years from 1964 to 1980 and the following results were obtained. In the period from pre-osteoarthritis to the first half of advanced stage, complaints were improved and progression of the disease was suppressed. In the period from advanced to terminal stage, this brace was used after surgery and walking ability was soon improved.

Adult↗
PubMed1981

[Hip dysplasia and congenital hip dislocation - a roentgenometric study in 110 families (author's transl)].

In human genetics and orthopedics quite different answers have been given to the question of hereditary transmission and frequency of hip dysplasia in families of children with congenital hip dislocation. We therefore have made roentgenometric measurements of 110 parents of children with congenital hip dislocation. In 25% we found abnormal flat acetabulae, whereas 12% had pathologic deep hips. This may propose a new concept of morphology of congenital hip dysplasia.

Acetabulum↗
PubMedDate not supplied

Morphometric study of the fetal development of the human hip joint: significance for congenital hip disease.

Hip joints (280) from 140 human fetuses, obtained from abortions and deaths in the perinatal period, were studied. The fetuses ranged from 8.7 to 40 cm in crown-rump length and are believed to be between 12 and 42 weeks in age. The joints were dissected, morphology inspected, and measurements taken of the depth and diameter of the acetabulum, the diameter of the femoral head, length and width of the ligament of the head, the neck-shaft, and torsion angles of the proximal femur. Regression models were fitted to determine which would best predict the growth pattern. Multivariate analysis of variance showed no significant differences between males and females or between the right and left sides. Acetabular depth was shown to be the slowest-growing hip variable, increasing less than fourfold in the period studied. Acetabular indices less than 50 percent indicate a shallow socket at term. Femoral head and acetabular diameter demonstrated a strong relationship (r = 0.860) and in many joints the femoral head diameter exceeded that of the acetabulum. Considerable variability was demonstrated in both femoral angles. The femoral angles showed only low correlation with the other hip variables. These observations indicate that soft tissue structures about the joint must play an important role in neonatal joint stability. The explanation of greater female and left side involvement in congenital hip disease must lie in factors other than growth changes of hip dimensions. Neither angle appears to be a useful indicator of normal joint development.

Acetabulum↗
PubMed1995

[Is the high hip center a solution for revision operation in acetabulum loosening of the hip prosthesis?].

In each of 20 anatomical specimens with an acetabular defect (Paprosky type 3b) we implanted an acetabular component in the position of a high hip center. We evaluated the interface area and the migration of the hip center in relation to the normal physiological hip rotation center. The interface area showed a wide interindividual range between 1049 mm2 and 527 mm2. This represented a percentage coverage of the hip component by between 44% and 22%, with an average of 31%. The vertical migration ranged between 13 mm and 35 mm, with a consecutive lateralization in all specimens. This lateral migration ranged from 10 mm to 30 mm. Besides this, there was also significant migration in the sagittal plane, with anterior migration by between 5 mm and 25 mm. On the basis of our findings, we do not recommended the implantation of an acetabular component in the position of a high hip center.

Acetabulum↗
PubMed1993

The treatment of intracapsular hip fractures with total hip arthroplasty in rheumatoid arthritis.

Total hip arthroplasty was performed on 41 patients with rheumatoid arthritis for 43 intracapsular hip fractures from 1971 to 1989. Followup, observation of clinical signs, and radiographs were conducted between one to ten years. Of the 41 patients, 25 had died by the end of the study. Total hip arthroplasty was found to be effective in relieving joint pain, and the walking ability of patients generally recovered to pre-injury status following the operation. Some patients experienced deterioration of the knee and ankle joints due to rheumatoid arthritis, and in such cases there was progressive loss of walking ability. Nevertheless, the function of the hip joint was well preserved, and most patients reported that pain had disappeared and the joint range of motion had returned to normal. In only one case was revision surgery necessary. There was little overall loosening of prostheses, and there were no problems concerning the durability of the artificial joint. The presence, therefore, of femoral neck fractures in patients with rheumatoid arthritis, who are to be encouraged to get out of bed and begin walking as soon as possible, is a strong indication for total hip arthroplasty.

Aged↗