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At least 487 records · Page 27Linked to original sources

Medial approach open reduction for congenital dislocation of the hip using the Ferguson procedure. A review of 31 hips.

Between January 1979 and October 1984, 31 congenitally dislocated hips in 19 patients were treated using open reduction via the medial approach, as described by Ferguson, at the Ankara University Faculty of Medicine. Patient age at operation ranged from 3 to 33 months (mean 12.1 months). The average follow-up was 94.7 months. All hips were evaluated both radiographically and clinically. Avascular necrosis of the femoral head was observed in 9.7% and slight, transient ischaemic radiographic changes of the femoral head in 22.6% of the hips; 25.8% of the hips have already undergone or are due to undergo subsequent surgery due to an insufficient radiographic result. The medial approach was found to be a reliable procedure for infants who have not had extensive previous conservative treatment and who are between 7 and 18 months of age.

Child, Preschool↗

The effect of hydroxyapatite coating on the fixation of hip prostheses. A comparison of clinical and radiographic results of hip replacement in a matched-pair study.

The efficacy of a total hip replacement with a hydroxyapatite-coated hip prosthesis was compared with that of an uncoated, cementless prosthesis of the same type. Preoperatively, there was no difference in the patient's diagnosis, hip score, age, and sex. All operations were performed by one surgeon in a standardized manner. The choice of the implant was randomized, and the follow-up period was equal for both types. The implant used was associated with a poor outcome due to a high incidence of early aseptic loosening. Probably because of a poor initial fixation, there was a significant difference in the clinical results after a short follow-up period when an additional HA layer was used. According to the patients' pain, migration of the implant, and presence of a progressive radiolucent line, use of the HA-coated prosthesis led to a significantly better result; however, we also found an increased rate of heterotopic bone formation in the HA-coated group. It was concluded that the HA coating improves the initial fixation of a hip prosthesis.

Durapatite↗

[Reliability, validity and responsiveness of the German short musculoskeletal function assessment questionnaire (SMFA-D) in patients with osteoarthritis of the hip undergoing total hip arthroplasty].

BACKGROUND: The aim of the present study was to check for reliability, validity and responsiveness of the Musculoskeletal Function Assessment questionnaire (SMFA-D) in patients with coxarthrosis undergoing total hip replacement. PATIENTS AND METHOD: In a prospective clinical trial the SMFA-D, the SF-36, the Harris Hip score, test of walking speed and the functional impairment according to the physician assessment were recorded. RESULTS: The reliability of the instrument could be demonstrated by a correlation coefficient of r = 0.78 for the function index and r = 0.84 for the bother index. Patients could be distinguished by the physician's assessment to show discriminative validity. Both indices correlated significantly with the Harris Hip score, scales of the SF-36 and the walking speed supporting the construct validity. The responsiveness could be shown with large effect sizes (1.04 for the function index and 1.02 for the bother index) at the three-month follow-up. CONCLUSIONS: The SMFA-D was found to be a reliable, valid and responsive instrument in patients with coxarthrosis undergoing hip replacement and the use of this instrument can be recommended.

Activities of Daily Living↗

Rotational acetabular osteotomy for the treatment of dysplastic hips with end-stage osteoarthrosis--a biological alternative to total hip arthroplasty?

We evaluated the results of rotational acetabular osteotomy (RAO) for the treatment of dysplastic hips with end-stage osteoarthrosis. Sixteen patients, aged 15-45 years at the time of surgery, were reviewed at a mean follow-up of 8 years (range 3-17 years). Remodeling of the hip joint occurred in half of the patients, with significant clinical improvement. A subsequent total hip arthroplasty, however, was done within 2 years after RAO in two other patients who had had large bone cysts in the femoral head and acetabulum. We suggest that RAO may be the procedure of choice for selected young patients, especially teenage patients, to postpone total hip arthroplasty.

Acetabulum↗

Hyaluronan in synovial fluid of patients with loose total hip prosthesis. Comparison with hyaluronan in patients with hip osteoarthritis and idiopathic osteonecrosis of femoral head.

The concentration and molecular weight of hyaluronan (HA) in the synovial fluid of the hip joint were determined in 13 patients (aged 62.8 +/- 9.4 years) who had undergone prior total hip arthroplasty(THA), 23 patients (aged 65.0 +/- 8.2 years) with osteoarthritis of the hip joint (OA), and 13 patients (aged 40.2 +/- 2.7 years) with idiopathic osteonecrosis of the femoral head (ION). A sample of synovial fluid was obtained during revision THA because of loosening of the total hip prosthesis for the THA group, and during the first replacement surgery or osteotomy for the OA and ION groups. The concentration of HA in the synovial fluid was 0.64 +/- 0.42 mg/ml in the THA group, 1.07 +/- 0.28 mg/ml in the OA group, and 1.30 +/- 0.56 mg/ml in the ION group. The concentration of HA in the synovial fluid of the THA patients was significantly lower than that of the OA and ION patients (P = 0.0156 vs OA, P = 0.003 vs ION). The molecular weight of HA was 309 +/- 88.3 x 10(4) Da in the THA group, 377 +/- 201 x 10(4) Da in the OA group, and 240 +/- 148 x 10(4) Da in the ION group; these values do not differ significantly (P = 0.259 vs OA, P = 0.174 vs ION). Among the THA patients, there was no relation between the concentration of HA and the age of the patient, length of time since the first operation, or type of prosthesis fixation; there was also no relation between the molecular weight of HA and each of these factors. These results suggest that a pseudosynovial membrane is regenerated after THA, and that it produces HA of the same molecular weight as that in patients with OA and ION, although in smaller quantities.

Adult↗

Hip implant infection. Treatment with resection arthroplasty and late total hip arthroplasty.

In 131 patients with an infected hip implant, treatment was surgical excision of the implant (resection arthroplasty) and delayed reconstruction with a total hip arthroplasty. Most of the patients had low-grade infections: only 5 percent had a temperature of 37.8 degrees C or higher and only 20 percent had wound drainage. Hip pain was the primary symptom of a deep infection in 90 percent. Staphylococci were the most frequently isolated causal organisms, recovered from deep tissue specimens in 84 patients. The hip was reconstructed six days to 32 years (mode, 429 days) after resection arthroplasty. At follow-up two to nine years after reconstruction, 88 percent of the 131 patients were free of infection. Recurrent sepsis was more common (p less than 0.05) in patients with incomplete acrylic cement removal or patients in whom reconstruction was performed less than 429 days after resection arthroplasty. Risk of recurrent sepsis was increased when gram-negative bacilli in pure or mixed cultures were found, but the difference was not statistically significant.

Adult↗

Test methods to detect hip and knee muscle weakness and gait disturbance in patients with hip osteoarthritis.

OBJECTIVE: To evaluate test methods for hip and knee muscle weakness and gait disturbance. DESIGN: Test-retest. SETTING: Orthopedic university clinic. PARTICIPANTS: Ten young (age, 36+/-6 y) and 13 elderly (age, 69+/-8 y) healthy volunteers and 11 patients (age, 69+/-8 y) with unilateral hip osteoarthritis (OA) were tested for muscular strength. Twenty-five volunteers (age, 42+/-14 y) underwent gait analysis. INTERVENTIONS: A dynamometer assessing maximal voluntary isometric force of hip and knee muscles and an optosensor walkway detecting limp were developed. Tests evaluated reproducibility and tolerance in patients with OA and elderly subjects. MAIN OUTCOME MEASURES: Relative coefficient of variation (CV%) and force (in newtons). RESULTS: CV% for unilateral strength measurements ranged from 7% to 12% for specific muscle groups. CV% for gait parameters ranged from 4% to 8%, except for the double-support phase. Tests were well tolerated, and no patient had to discontinue because of fatigue. Differences related to sex, age, and disease were detected. CONCLUSIONS: Our dynamometer system provides reliable measurements of hip and knee muscle strength in young and old people, and variation is comparable to previous data. Our photocell technique for gait analysis is reliable in people with normal gait. Both methods are attractive because they are affordable, nonstationary, and easy to use.

Adult↗

Cemented hip arthroplasty with a novel cerclage cable technique for unstable intertrochanteric hip fractures.

Thirty-nine consecutive patients with unstable three and four part intertrochanteric hip fractures were treated with cemented bipolar hip arthroplasty. A standard length primary femoral component was used with a novel technique of cerclage fixation of the trochanteric bone fragments allowing retention of the femoral calcar. At one year minimum follow up, there was no loosening or subsidence of the femoral components. All trochanters healed. One dislocation and one deep infection occurred. Unstable three and four part hip fractures can be treated with a standard femoral stem and cerclage cabling of the trochanters. The technique allows safe early weight bearing on the injured hip and had a relatively low rate of complications in our series.

Aged↗

Pre-operative planning and gait analysis of total hip replacement following hip fusion.

A computer-based pre- and post-operative analysis of total hip replacement (THR) is presented. The analysis was performed by using and innovative combination of X-ray measurements and gait analysis. The several important biomechanical factors that affect effective THR are analysed in a test clinical case of conversion of hip fusion into THR. Geometrical positioning of the artificial joint should restore correct motion and adequate leverage of the surrounding muscles in order to exert the appropriate functional joint moments. Hip joint centre positioning pre- and post-operation was evaluated using a computer-based X-ray measurement tool. This enabled the calculation of the medio-lateral and proximal-distal off-set of the joint centre, the lever arms of the abductor muscles and the limb length discrepancy. Pre- and post-operative function was also evaluated using gait analysis, including joint kinematics, kinetics and electromyography. The whole analysis suggests that a good restoration of joint motion, a regression of pelvic compensation and a phasic activity of gluteus medius occur only when a good positioning of the prosthetic hip joint is obtained. This study proved a fundamental role played by these two computer-based tools in the support of the clinical decision making process.

Arthroplasty, Replacement, Hip↗

Comparison of cemented and cementless total hip arthroplasty in patients with bilateral hip arthroplasties.

A consecutive series of 36 patients underwent primary cemented total hip arthroplasty followed by primary cementless total hip arthroplasty of the contralateral hip. Clinical pain scores between the cementless and cemented hips were not different. Subjectively, patients either had no preference or preferred the cementless side. Comparison of results in the same patient eliminates variability introduced by differences in sex, weight, comorbidities, bone quality, and activity level. Control of these factors permits more meaningful comparison of the type of fixation.

Adult↗

Influence of the Crowe rating on the outcome of total hip arthroplasty in congenital hip dysplasia.

Few studies have examined the relationship between the severity of congenital dysplasia of the hip (CDH) and the clinical outcome of total hip arthroplasty. The authors have used a prospective design to study this question, using the Crowe grade to assess the severity of CDH. There were 71 patients with CDH operated on using the S-ROM total hip (Joint Medical Products, Stamford, CT); the control group was composed of 22 patients without CDH operated on using the same implant during the same period as the CDH patients. The patients with mild CDH did not have a different outcome from the patients without CDH with respect to Harris hip score or limp. The higher the Crowe grade, the more complications occurred. It was also found that the patients in whom the true acetabulum was not used had a significantly higher incidence of limp.

Female↗

Neglected congenital dislocation of the hip. Role of computed tomography and computer-aided design for total hip arthroplasty.

Computed tomography (CT) provides important three-dimensional anatomic details in congenital dislocation of the hip that are useful for total hip arthroplasty (THR) and are not obtainable with conventional radiographic evaluation. In this study, 84 patients (119 hips) with congenital dislocation of the hip were evaluated with CT before surgery. Specifically, both the acetabulum and the femur were analyzed to make the best selection of the prosthesis. The average anteversion of the acetabulum was 23 degrees, with an opening of 30.9 mm and a depth of 14.7 mm. The bone stock of the true acetabulum was calculated and the average available diameter for the acetabular implant was 44.9 mm. The CT topogram revealed the true leg-length discrepancy (average 0.5-1.9 cm), and the amount of a shortening osteotomy when necessary was determined. Finally, to determine the stem with optimum fit and fill, a three-dimensional reconstruction of the femoral canal using CT data and computer-aided design (CAD) was matched with a three-dimensional geometry of several stem designs and sizes obtained from a CAD system.

Computer-Aided Design↗

Hip dislocation revealing hip tuberculosis. A case report.

Hip dislocation is an uncommon presentation of hip tuberculosis. We report a case in an 18-year-old woman with active hip tuberculosis. An attempt to reduce the dislocation 7 weeks into antituberculous therapy was followed by necrosis of the femoral head. Although severe forms of hip tuberculosis are common in endemic areas, dislocation is exceedingly rare. Capsule laxity and/or synovial hypertrophy probably contribute more to the occurrence of dislocation than does the accumulation of pus.

Adolescent↗

Quadriceps muscle wasting persists 5 months after total hip arthroplasty for osteoarthritis of the hip: a pilot study.

AIMS: To determine whether additional muscle fibre wasting of the ipsilateral vastus lateralis muscle occurs in the early postoperative period after total hip arthroplasty for osteoarthritis of the hip and whether there is an improvement in preoperative measures of quadriceps muscle thickness, strength, pain and function over a 5-month postoperative period. METHODS: Twelve patients had ipsilateral needle quadriceps biopsy for muscle morphology and bilateral quadriceps muscle thickness ultrasound preoperatively, 5 days and 4 weeks postoperatively and a further muscle thickness measurement at 5 months. Seven additional patients and five age-matched control subjects had bilateral quadriceps muscle ultrasound thickness preoperatively, 6 weeks and 5 months postoperatively, with assessment of quadriceps muscle dynamometry, pain scores and Timed Up and Go (TUG) test. RESULTS: Preoperatively, all 19 patients demonstrated significant atrophy of the ipsilateral compared with the contralateral quadriceps muscle (P = 1.8 x 10(-7)) on muscle ultrasound, which persisted at 5 months follow up (P = 0.009). Muscle morphology preoperatively showed type 2A and 2B muscle fibre atrophy on needle muscle biopsy, with further atrophy of all three fibre types (P = 0.029) at 5 days postoperatively associated with a fibre type shift from type 1 to 2A fibres (P = 0.0011) at 1 month. There was improvement in hip pain postoperatively and a significant improvement in the TUG test (P = 0.007). However, there was no improvement in muscle strength on dynamometry. CONCLUSIONS: There is significant ipsilateral quadriceps atrophy and weakness with 2A and 2B fibre atrophy preoperatively in patients with osteoarthritis of the hip with exacerbation and further atrophy of all three fibre types 5 days postoperatively. Postoperative follow up showed that the reduction in ipsilateral quadriceps muscle thickness persisted at 5 months despite physical rehabilitation. Patients did note significant improvement in pain postoperatively and improvement on functional assessment with the TUG test. Other therapeutic strategies may have to be developed to reverse disuse muscle atrophy.

Aged↗

Evaluation of the 'Lequesne's false profile' of the hip in patients with hip osteoarthritis.

OBJECTIVES: To compare the value of Lequesne's false profile (LFP) radiograph of the hip and antero-posterior (AP) X-ray of the pelvis in the assessment of joint space narrowing (JSN) and osteophyte (Ost) in patients with hip osteoarthritis (OA). METHODS: AP and LFP radiographs of the hip were performed using a standardized method in 50 consecutive patients with hip OA. JSN and Ost were graded at different days by a single observer blinded for patients identity, using a six point scale (JSN:0-5) and a four point scale (Ost:0-3) from AP and LFP respectively. Scores obtained from AP and LFP were compared. RESULTS: Mean JSN grade was significantly higher for LFP (2. 7+/-1.0) than AP (2.4+/-1.2) (P=0.001). It was identical for AP and LFP in 28 patients (56%) while the highest grade was found on LFP in 16 (32%) and on AP in 6 (12%). No significant difference between LFP and AP was found for osteophyte grading. CONCLUSION: These data suggest that the combination AP+LFP provide more information than AP alone for the evaluation of joint space narrowing in about one third of patients. LFP may be helpful for the radiographic assessment of OA changes particularly in structure modifying drugs evaluation.

Aged↗

[Real-time sonography of the infant hip joint in the early diagnosis of congenital hip dysplasia].

The ultrasonic examination of infant hip joint means a great advantage in early diagnosis of congenital hip dysplasia. The sonographic type classification by Graf enables the experienced examiner to make up a differentiated diagnostic-therapeutic concept as early as possible. Therapeutic omissions just as well as exaggerated therapeutic measures can be avoided. Consequently the prognosis of hip joint dysplasia is considerably improved by ultrasonic examination of new-born hip joints.

Diagnosis, Differential↗

Fixation with poly-L-lactic acid screws in hip osteotomy: 68 hips followed for 18-46 months.

This study evaluated 68 consecutive hip osteotomies in 61 patients using absorbable poly-L-lactic acid screws for fixation. 47 hips underwent a rotational acetabular osteotomy, 17 hips Chiari's pelvic osteotomy, and 4 hips transtrochanteric rotational osteotomy. Cortical screws were used to transfix the osteotomized acetabulum, and cancellous screws to reattach the intraoperatively osteotomized greater trochanter. The average age at surgery was 35 (12-49) years. The mean duration of follow-up was 32 (18-46) months. All the osteotomized acetabulums united well, but 4 of 54 trochanteric osteotomies failed to unite.

Adult↗

Hip abductor muscle activity as subjects with hip prostheses walk with different methods of using a cane.

BACKGROUND AND PURPOSE: Using a cane held contralateral to a prosthetic hip is presumed to be an effective way to reduce the demands on the hip abductor (HA) muscles and, therefore, the forces on the implant. In this study, surface electromyographic (EMG) activity was measured from the HA muscles to test this notion. SUBJECTS: Twenty-four active subjects (9 female, 15 male) with unilateral prosthetic hips were tested. The subjects, aged 40 to 86 years (mean = 63.3, SD = 10.7), were not regular cane users. METHODS: Surface EMG activity and cane force were analyzed while the subjects walked with the cane held (1) contralateral to the prosthesis (CL-CANE), (2) ipsilateral to the prosthesis (IL-CANE), and (3) contralateral to the prosthesis with instructions for the subject to push with a "near-maximal effort" (CL-CANE+). RESULTS: Only the following conditions showed a change in HA muscle EMG activity as compared with not using a cane: CL-CANE = -31.1%, CL-CANE+ = -42.3%. CONCLUSION AND DISCUSSION: Holding the cane contralateral to the prosthetic hip appears to be an effective method of reducing demands on the HA muscles.

Adult↗