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PubMed1977

The radiology of the hip joints and pelvis in cerebral palsy.

Thw radiological appearances found in the pelvis and hip joints in 79 patients with cerebral palsy, aged 5--16 years, have been studied. These findings have been recorded and correlated with the clinical severity and distribution of the disease. Subluxation of the hip joints was found in 14% and dislocation in a further 6%. Spasticity was the predominant neuromuscular handicap in 69 out of 79 cases (88%). The acetabular angle and femoral neck shaft angle were related to the degree of migration of the femoral head. The acetabular angle, iliac angle, iliac index and femoral neck shaft angle were all significantly increased in the deranged group. In the dislocated group, the mean neck-shaft angle was 154 degrees. When the degree of spasticity was asymmetrical, there was a striking relationship between the laterality of the spasticity and the laterality of the deranged hip, pelvic obliquity and increased acetabular angle. A typical teardrop-shaped femoral head was seen in 48% spina bifida occulta of the lower lumbar and sacral spine in 32% and pseudoarthrosis in 3.8%. No ectopic calcification or ossification of soft tissue was noted. An awareness that these children are at risk from subluxation and dislocation of the hip and the importance of early diagnosis and treatment are emphasised.

Adolescent↗

PubMedDate not supplied

[Ultrasonographic examination of the hip joint region and bony pelvis in cattle].

Transcutaneous and transrectal ultrasonographic examination of the hip joint region and the pelvis was carried out in 7 cadavers, transcutaneous ultrasonography in 17 healthy young and adult cattle, and transrectal sonography was performed in 12 healthy cows in order to study the normal ultrasonographic appearance of these regions. 7.5 MHz linear-, 5.0 MHz and 3.5 MHz convex transducers and a 7.5 MHz rectal probe were used. The bone surfaces of the greater trochanter, the femoral neck and head, the acetabulum and the other pelvic bones were visualised as hyperechoic contours. The coxofemoral joint space was identified in all cadavers and live cattle. The joint pouch could not be visualised, neither in cadavers nor in live cattle. After experimental filling of the coxofemoral joint pouch by injection of 35-45 ml eosin-solution it appeared as a large anechoic zone between the articular surface and the echogenic joint capsule. The inner contours of the pelvic girdle, both iliosacral joint spaces, the abdominal aorta and the external iliac arteries were depicted clearly by transrectal ultrasonography. The practical application of diagnostic ultrasound in these regions is demonstrated in clinical patients suffering from a septic coxarthritis and a sequestration of a part of the tuber coxae following an open fracture. These results serve as reference data for ultrasonographic investigation of disorders of the hip joint and the pelvic region in cattle.

Animals↗

PubMed2003

Improvement of the reliability of ceramic hip joint implants.

The aim of this article is to present the optimization of a proof test procedure of ceramic hip joint ball heads. The proof test rejects defective samples in the production line before being implanted into human body. Thereby on every ceramic ball head a static load is applied, which is somewhat higher than the maximum physiological load. The magnitude of the applied load should not damage the samples which are free of flaws in the high stress area. The configuration of the proof test influences the stress distribution in the ball head, which should be similar to the physiological case. To determine the stress distribution, a non-linear finite element (FE) analysis was performed and the results were validated by measurements. With an iterative approach based on FE calculations the proof test configuration was optimized in such a way that the stress distribution in the ball head is similar to the stress distribution in vivo. In this study all ball heads showed very high fatigue resistance after being proof tested and fulfilled the requirements of the FDA (Food and Drug Administration, USA) described in the Guidance Document for the Preparation of Premarket Notifications for Ceramic Ball Hip System. The probability of a fracture of an implanted ceramic ball head can be decreased by the presented optimized proof test procedure. Latter can thus improve the reliability of ceramic hip joint ball heads. The study was supported by the KTI (Commission for Technology and Innovation, Switzerland).

Computer-Aided Design↗

PubMed2002

Posterior fracture dislocation of the hip joint: the value of the obturator-oblique view with the hip still dislocated.

OBJECTIVES: To determine the value of the Judet oblique views taken while the hip is still dislocated. STUDY DESIGN: Radiological review. SETTING: Level I trauma center. METHOD: In addition to the traditional views in fifty of 110 fracture-dislocations, Judet views were carried out with the hip still dislocated. Each of the respective views was viewed with the reviewer blinded to diagnosis and the fracture classified according to the information available on that view. The percent accuracy of each view was then calculated by comparing radiologic with intraoperative classification. Under the pretext that if any view enabled a more accurate classification of the fracture, it must be providing more information, we assessed the quantitative value of each radiologic view according to our ability to accurately classify the fracture. RESULTS: Using the CT scan alone, classification was accurate in 82 percent of cases because the CT often overdemonstrated the degree of comminution. When the added information available from the traditional radiographs was included, there was only a slight improvement (82 percent versus 84 percent). This was increased to 96 percent when the obturator-oblique dislocated view was included. CONCLUSION: Because it provides an uninterrupted view of the posterior wall, demonstrates the displacements of fragments, and provides a comparison for the reduced view, which greatly augments the available information, the obturator-oblique dislocated view should be done routinely in the assessment of all posterior fracture dislocations of the hip joint.

Hip Dislocation↗

PubMed1993

Iowa FICSIT trial: the feasibility of elderly wearing a hip joint protective garment to reduce hip fractures.

Hip fractures exact a heavy toll in the elderly population. While intervention strategies are being investigated to reduce the numbers of geriatric falls and to improve the body's resiliency, the geriatric population remains at risk for the mortality and morbidity associated with fractures. The Iowa FICSIT site is investigating the feasibility of passive protection of the proximal femur through the use of hip pads. The pad is designed to disperse throughout the pad the energy created in a fall. The focus of the Iowa trial is to determine if elderly will wear hip pads for the majority of their waking hours. Thirty subjects are being recruited from each of six elderly populations who are at high risk to fall and at increased risk of injury. To facilitate compliance, the following strategies are utilized: run-in period, graduated implementation, tailoring of wearing times, and self-report of compliance. Outcome measures include compliance rates and injuries sustained during falls.

Accidental Falls↗

PubMed1990

[Supercilium acetabuli. A stress indicator of the hip joint cartilage].

A thousand radiographs of the hip joints in adults were evaluated quantitatively and the following statistical conclusions were drawn: the normal forms of the supercilium acetabuli are either parallel or convex. Wedge-shaped supercilia indicate increased stress on the cartilage only in cases with hip dysplasia. A supercilium of more than 4mm raises the suspicion of increased stress on the cartilage. Normally, the joint space as shown on a radiograph does not fall short of 3mm. Eight formulas have been defined which can be used after planimetry of the supercilium and the articular surface in order to indicate increased stress on the cartilage and a risk of developing an arthrosis of the hip. These formulae are of practical value if the radiographs appear normal to visual inspection.

Acetabulum↗

PubMed1978

The hip joint in Paget's disease (Paget's "coxopathy").

Three hundred patients with Paget's disease around the hip joint are compared with 300 control patients who did not have Paget's disease. The incidence of joint degeneration in the two groups is similar at all ages, and there appears to be no predisposition to joint degeneration in patients who have Paget's disease. A feature of the hip joints is that in approximately half there is joint narrowing to less than 3 mm affecting a portion or the whole of the joint surface, which, together with the incidence of protrusio acetabuli, is probably a specific manifestation of the joint changes associated with Paget's disease.

Aged↗

PubMed2001

Radiographic osteoarthritis of the hip joint in Turkey.

The prevalence of hip osteoarthritis (OA) varies greatly across different geographic areas. Limited data exist about the prevalence of radiographic hip OA in the Turkish population. The aim of this study was to estimate the prevalence of radiographic hip OA in Turkey utilizing a random sample. That sample consisted of radiographs filed at the Department of Urology, Gazi University Hospital, Ankara, and included patients aged 25 years and older (range 25-97 years). Plain supine abdominal radiographs and intravenous pyelographies were evaluated using the Kellgren and Lawrence (K&L) grading system. Evaluations were made of 1,248 hips in 682 patients (205 women and 477 men). Overall, 8.8% of the hips evaluated had radiographic hip OA (K&L grade 2 or higher). Both hips were visible in 566 patients. Of those patients 11.7% had radiographic hip OA in either one or both hips (9.4% of women and 12.6% of men), and 51.5% of whom had bilateral findings. Prevalence increased with age and was 1.9%, 16.1%, and 21.5% for age ranges 25-39, 40-54, and 55 years and older, respectively. Patients aged 40 years and older had significantly more radiographic hip OA than those younger than 40 years (P<0.001). Men had a higher frequency than women after the age of 40 years, but this did not reach statistical significance. In most patients radiographic findings indicated only mild disease. Three patients had grade 3 disease and only one patient (aged 68 years) had grade 4 disease. Among patients aged 40 years or older. 1.1% had grade 3 or 4 disease. These findings suggest that K&L grade 2 OA changes emphasizing osteophytes at hip joints are not uncommon in the Turkish population, especially among those aged 40 years and older. However, frequency of moderate or severe radiographic hip OA may be low.

Adult↗

PubMed2004

[Quantitative evaluation of deformity of the iliac artery during extension and flexion of the hip joint: three-dimensional evaluation using MDCT].

We performed CT-angiography twice, first hip joint extension, followed by second flexion. Using vessel analysis software, we placed several points of interest at equal intervals on the center line of the iliac artery, from the bifurcation to the femoral artery inguinal portion, and recorded the their three-dimensional coordinates. We also marked the circumference, which passes by three points that add the respective next point and prior point to each reference point. This curvature (the inverse number of the radius) was utilized as the index that displays crookedness. This method was able to estimate quantitatively the grade of crookedness, and, by comparing an equidistant point from the bifurcation, to show the changes in grade at flexion of the hip joint.

Aged↗

PubMed2004

Factors influencing hip joint space in asymptomatic subjects. A survey of 4151 subjects of the Copenhagen City Heart Study: the Osteoarthritis Substudy.

OBJECTIVE: The aims of the study were to investigate the distribution of hip joint space width (JSW) in asymptomatic subjects without radiologic evidence of degeneration, and investigate the influence of age, sex, physical parameters, occupational activity, and smoking on JSW. MATERIALS AND METHODS: The distribution of minimum JSW was determined in hip joints in standardized, weight-bearing pelvic radiographs of the Copenhagen City Heart Study: The Osteoarthritis Substudy cohort of 4151 subjects. Asymptomatic subjects without radiologic osteoarthritis were included (1018M/1554F). Occupational exposure to repeated daily lifting, smoking, and physical parameters were registered for each individual. RESULTS: Overall, female minimum JSW was significantly smaller compared with male JSW (P < 0.0001). Female minimum JSW decreased significantly with age (P < 0.0001), while male minimum JSW remained relatively unaltered throughout life (P(right) = 0319, P(left) = 0.18). Minimum JSW correlated positively with height, weight, and BMI, as did femoral head radius. Multiple logistic regression analysis revealed significant influence of sex and age on minimum JSW in females only. Positive or adverse effects of cigarette smoking on hip JSW were not documented. Type and duration of occupational exposure to repeated daily lifting did not affect hip JSW significantly. CONCLUSION: Minimum JSW decreased progressively with age in women, while it was unaltered in men. A history of smoking or different occupational exposure to repeated daily lifting did not influence minimum hip JSW significantly. Differences in body mass index, height or weight did not significantly influence minimum hip joint JSW.

Adult↗

PubMed1985

[Experimental study of hypertrophy of the femoral head--with special reference to the effects of the surgical procedure on the hip joint].

This experimental study was performed to clarify how a surgical procedure to the hip joint causes hypertrophy of the femoral head. Young rabbits were used for this experiment. The following results were obtained. In the rabbits with sectioned ligamentum teres, some cases showed complete dislocation on X-ray. The incidence of the hypertrophy of the femoral head was very low in this group. Except in these rabbits with dislocation, the hypertrophy of the femoral head appeared in any group subjected to surgical procedure, and at especially high rates in those subjected to the section of ligamentum teres and/or edge resection of acetabular cartilage. In the cases in which the edge of the acetabular cartilage was resected, and in other cases of surgical procedure as well, acetabular dysplasia often resulted. In these cases the hypertrophy of the femoral head was observed more frequently than in others. In summary, surgical procedure to the hip joint and postoperative abnormal stress to the femoral head contribute to the development of the hypertrophy of the femoral head especially in the cases in which acetabular factors are not negligible.

Acetabulum↗

PubMed2005

Trunk rotation torques through the hip joints during the one- and two-handed backhand tennis strokes.

The aim of the present study was to compare kinetically the roles of the lower extremities in generating trunk rotation in the tennis one-handed and two-handed backhand strokes. Fourteen male collegiate tennis players, seven with a preference for the one- and seven with a preference for the two-handed technique, were recruited as participants. The motion of each backhand stroke was filmed using two high-speed cine-cameras, and the ground reaction forces on the feet were measured separately using two force platforms to determine the joint moments and joint reaction forces at the hip, knee and ankle joints. A significant difference in hip joint moments between the two types of stroke was found in the phase from the start of forward rotation of the pelvis to the start of racket forward movement. For trunk rotation, the one-handed backhand players exerted a large joint moment in the front leg, whereas the two-handed backhand players exerted a large joint moment in the back leg. The exertion of a large hip joint moment in the latter stroke was comparable with the exertion in a forehand stroke reported previously.

Adult↗

PubMedDate not supplied

[Stress relief of the hip joint by the Thomas splint].

The Thomas Splint is mainly administered to relieve weight from the hip joint. Theoretically the leg is bypassed by transmitting the body weight directly from the pelvis to the floor.--Load transmission via a Thomas Splint was measured with an orthosis strain gauged at the ischial interface area and at the foot plate. The results show, that about one half of the weight will bypass the joint through the orthosis. The Thomas splint ist unsuitable in cases when complete weight relief from the hip joint is necessary.--These results did not depend on whether the floor was flat or ascending, or whether stairs were climbed. The lateral bar never carried more then 25% of the force transmitted.

Adult↗

PubMed1984

Contact study of the hip joint. Load-deformation pattern, contact area and contact pressure.

Contact study of the human hip joint was performed in order to understand load-deformation pattern under compressive loading, contact area and contact pressure by our method. Weight-bearing function of the hip joint was confirmed. Deformation of articular cartilage and subchondral bone were made reasonably and joint congruity was considered to be obtained with increasing load. Neither contact area nor distribution of the contact pressure were symmetrical or concentric, and both were dependent on the magnitude of load. The relationship between weight-bearing and early cartilage degeneration was discussed.

Adult↗

PubMed2006

Prediction of gait outcome with the knee-ankle-foot orthosis with medial hip joint in patients with spinal cord injuries: a study using recursive partitioning analysis.

STUDY DESIGN: Retrospective study of the degree of gait independence achieved by persons with spinal cord injury (SCI) using knee-ankle-foot orthosis with a medial single hip joint (MSH-KAFO). OBJECTIVE: To examine the effects of the neurological level, degree of paresis, age, and inhibitory physical/other factors on the gait with a MSH-KAFO in patients with SCIs. SETTING: Three university hospitals and two rehabilitation hospitals in Japan. METHODS: The 45 patients (36 men, nine women) examined included 10 with injuries in the cervical cord between C6 and C8 (group C), 20 with injuries in the upper-middle thoracic cord between T4 and T10 (group UT), and 15 with injuries in the lower thoracic-lumbar cord between T12 and L1 (group TL). Mean age was 34.0 years (range 16-68 years). Of these patients, 13 used the Walkabout, four used the gear joint, and 28 used the Primewalk as the medial hip joint. Recursive partitioning, which predicted the final status of gait from the level, degree of paresis, age, and inhibitory factors, was performed, and a decision tree for gait was constructed. Inhibitory factors were spasticity, involuntary spasms or muscle contractions, pain, contracture, weakness of the upper extremities, and decreased motivation to perform gait exercise. The degree of gait independence was rated on the following five-point scale: outdoor independent gait (5 points), indoor independent gait (4 points), indoor supervised gait (3 points), indoor assisted gait (2 points), and gait within parallel bars (1 point). New branches were added to the decision tree for gait based on the clinical experience, thereby constructing a new decision tree. RESULTS: The coincident ratio between the value predicted on the basis of the decision tree of gait and the value actually observed was 53.3%. The coincident ratio between the value predicted on the basis of the modified decision tree of gait and the actually observed value was 68.9%. CONCLUSION: The results provide valuable information to medical teams that may assist prescription of gait orthoses.

Adolescent↗

PubMed2000

Total hip arthroplasty after arthrodesis of the hip joint.

The results of 15 conversions of a hip arthrodesis into a total hip arthroplasty performed in the years 1980-1995 are reported. Fifteen patients (8 men, 7 women) underwent total hip arthroplasty 30.9 (range 2-61) years after spontaneous or operative fusion of a hip joint. The primary indications of the conversion were low-back pain (n = 10), knee pain (n = 2) and hip problems (n = 3). At follow-up examination 5.4 (range 2-13.3) years postoperatively, the Harris Hip Score averaged 86.0 (range 70.1-99.0). Six patients were pain-free, 7 had less pain, 2 felt no improvement of pain. All patients confirmed that they would undergo the operation again. The Trendelenburg sign was negative or mild in 8 patients and moderate to severe in 7. Aseptic loosening of 2 stems (1 cemented, 1 cementless) and 2 deep infections required revision surgery. We conclude that this operation can lead to satisfactory results even after a long duration of the arthrodesis. However, full function with no pain and a negative Trendelenburg sign could be obtained in only 20% (3/15) of the cases.

Adult↗

PubMed2005

Application of three-dimensional magnetic resonance image registration for monitoring hip joint diseases.

The purpose of this study was to estimate the accuracy of a method in which three-dimensional (3D) magnetic resonance (MR) volume registration is used for monitoring hip joint disease. Data were analyzed using a normalized cross-correlation (NCC) algorithm involving a user-selected 3D box including the proximal femur. Most of the femoral head was not included in the 3D box because it can become deformed during the course of disease. The accuracy of registration around the femoral head was evaluated using five phantoms and clinical MR data of 17 patients with hip joint disease. In the phantom experiment, registration accuracy was evaluated using four fiducial markers attached to the femoral head. In the experiment using clinical data, registration accuracy was evaluated using a landmark in the femoral head. The registration accuracy in the phantom and clinical experiment was 0.43+/-0.18 mm (S.D.) and 1.12+/-0.46 mm (S.D.), respectively. The former is a value less than half the minimum dimension of a voxel (1.25 x 1.25 x 1.0 mm). Although the latter is slightly larger than the minimum dimension of a voxel, actual errors would be smaller because of the uncertainty in landmark localization. In conclusion, the present method based on an NCC algorithm can be used to accurately register serial MR images of the femoral heads with an error on the order of a voxel. We believe that this method is sufficiently accurate for monitoring hip joint diseases.

Algorithms↗

PubMed1984

The kinematics of hip joints: normal functioning.

This paper describes the use of an electrogoniometer to measure angular movements of the hip joints of a large number of 'normal' people. The object of the study was to establish a statistically significant data base for the movements of the hip joints during functional activities against which the movements of pathological hips could be compared. The measurement and the analysis used to establish 'normality' in males and females over a wide age range are introduced. The data are examined for the existence of any sex or age related gait variations, and the conclusion is that there are only minor variations. Comparison with pathological hips will be reported later.

Adolescent↗