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PubMed1997

Prevalence of hip problems in the population aged 55 years and over: access to specialist care and future demand for hip arthroplasty.

To determine the prevalence of hip problems in the population aged 55+, a postal questionnaire was sent to a multistage stratified random sample of residents of a health district with an over-55 population of 210,000. An initial four page postal questionnaire produced an 86% response rate from 18,827 eligible cases. A subsequent detailed questionnaire (with a response rate of 78%) then determined the prevalence of severe pain and severe disability amongst those with hip problems. The prevalence of those with existing hip replacements is estimated at 32.1/1000 (95% CI 29.5-34.9). An estimated 13.5/1000 (95% CI 12.4-14.7/1000) displayed levels of pain and disability consistent with a current need to consider arthroplasty. In addition, it appears that the over 75s are less likely to have access to appropriate surgery. Unless health authorities and, increasingly, general practitioners consider purchasing more hip replacements, the prevalence pool of those who could benefit will inexorably rise.

Age Distribution↗
PubMed1988

Cutaneous fistula communicating with the hip in a patient with a painful total hip prosthesis. Demonstration by radionuclide arthrography.

Radionuclide arthrography is becoming increasingly useful in the evaluation of femoral component loosening in patients with a painful total hip prosthesis. Additional potential advantages of radionuclide arthrography include detection of abnormal communications with the hip, such as bursae, abscess cavities, and fistulas. A case of cutaneous fistula communicating with the hip in a patient with loosening and infection of the femoral component of the total hip prosthesis that is clearly demonstrated by radionuclide arthrography is presented.

Aged↗
PubMed1989

Streptococcal antigen-induced dislocation and dysplasia of the hip in newborn rats. Radiologic and histologic evaluation of a model of congenital dislocation of the hip.

Dislocation of the hip developed in 62% of newborn rats with streptococcal antigen-induced synovitis. Age at the time of the induction of synovitis is critical since dislocation is not observed in older rats. Synovitis with distention and laxity of the joint capsule is most likely responsible for the hip dislocation. Although congenital dislocation of the hip in children is not mediated by an inflammatory process, the current model of dislocation of the hip in rats is similar in being critically age-dependent, and associated with ligamentous laxity. Our model may be helpful in studying this important clinical entity.

Age Factors↗
PubMedDate not supplied

Factors relating to hip joint arthritis following three childhood diseases--juvenile rheumatoid arthritis, Perthes disease, and postreduction avascular necrosis in congenital hip dislocation.

This article discusses factors that relate to the prognosis for development of hip joint arthritis following juvenile rheumatoid arthritis (JRA), Perthes disease, and postreduction avascular necrosis in congenital hip dislocation (CDH). In JRA, the integrity of the articular cartilage determines prognosis. In Perthes disease, prognosis is strictly related to the shape of the hip. In postreduction avascular necrosis in CDH, half the patients have a prognosis primarily related to hip joint shape, and half have a prognosis apparently more related to the integrity of the articular cartilage.

Adult↗
PubMed1990

Insertion of a prosthetic hip into a total hip allograft. Case report.

We describe a patient in whom a total hip replacement had failed and who subsequently fractured her proximal femur. The prosthetic hip and the surrounding bone were excised and replaced by a matched pair of allograft components. She obtained seven years of pain free hip function before the graft showed radiographic signs of failure; it was then replaced by a new prosthetic hip.

Arthritis, Rheumatoid↗
PubMed1991

Total hip arthroplasty in high congenital dislocation. 21 hips with a minimum five-year follow-up.

Total arthroplasty was performed on 21 congenitally dislocated hips in 18 women. In all cases the femoral head was dislocated cranially at least one-fifth of the height of the pelvis. The components were both cemented, the acetabulum being replaced to its original position. The acetabular roof was reconstructed by bone graft in 13 hips, and trochanteric osteotomy was done in 18 hips. The patients were assessed at a median follow-up time of 7.5 years when their median age was 54 years. Nine patients had been revised or required revision. At follow-up the average functional score (according to Charnley) was 6 for pain, 4 for walking ability and 5 for range of motion. The Harris hip score was 82. The patients' subjective evaluation of their satisfaction with the late results on a visual analogue scale was 93, range 23 to 100. The high loosening rate in such patients demands regular follow-up and preparedness for revision surgery.

Acetabulum↗
PubMed2000

Cemented total hip arthroplasty with autogenous acetabular bone grafting for hips with developmental dysplasia in adults: the results at a minimum of ten years.

We carried out primary cemented total hip arthroplasty (THA) on 25 hips in 21 patients with developmental dysplasia of the hip, using autogenous acetabular bone grafts. The socket was placed at the level of the true acetabulum and bone from the femoral neck was used as graft. Five hips were excluded, leaving 20 which were followed up for a mean of 12.9 years (10 to 18). The mean modified Merle d'Aubigné and Postel functional scores were 5.6 for pain, 4.3 for mobility and 4.2 for range of movement. Radiological examination showed aseptic loosening in three sockets but not in the stems. The bone grafts had united and showed no evidence of late failure.

Adult↗
PubMed2001

The contribution of reduced peak accrual of bone and age-related bone loss to osteoporosis at the spine and hip: insights from the daughters of women with vertebral or hip fractures.

The genetic hypothesis states that a daughter will resemble her mother by about 50% in a given trait because she shares, on average, half her genes. We used this trait resemblance in mothers and daughters to determine whether abnormalities in volumetric bone mineral density (vBMD) or bone size in women with fractures originate in growth or aging. vBMD and volume of the third lumbar vertebra and femoral neck were estimated using posteroanterior (PA) scanning by dual-energy X-ray absorptiometry (DXA). Vertebral volume was estimated as (scan area)(3/2) and femoral neck volume was pi* (width/2)(2)* height. vBMD was bone mineral content (BMC)/volume. The data were expressed as age-specific SD or Z scores (mean +/- SEM). Vertebral vBMD was reduced by -0.98 +/- 0.14 SD (p < 0.001) in 34 women with vertebral fractures, and by -0.36 +/- 0.13 SD (p < 0.05) in their 44 premenopausal daughters. The vBMD deficit in the daughters (relative to age-matched controls) was no different from one-half their mothers' deficit (relative to their age-matched controls). Vertebral volume was reduced in the women with vertebral fractures relative to age-matched controls (-0.77 +/- 0.15 SD; p < 0.001), but not in their daughters (-0.17 +/- 0.13 SD, NS). The 31 women with hip fractures and their 41 premenopausal daughters had no deficits in vertebral volume or vBMD. Femoral neck vBMD was reduced in the women with hip fractures (-1.24 +/- 0.12 SD; p < 0.001) but not in their daughters (-0.17 +/- 0.13 SD, NS). Femoral neck volume was increased by 0.98 +/- 0.30 SD (p < 0.05) in women with hip fractures (relative to age-matched controls) and by 0.54 +/- 0.14 SD (p < 0.001) in their daughters (relative to age-matched controls); that is, about one-half that of their mothers. We propose that women with vertebral fractures have reduced vertebral vBMD because of, in large part, reduced accrual of bone during growth (because the deficit in their daughters was almost one-half their mothers' deficit); reduced vertebral volume in women with vertebral fractures is caused by reduced periosteal apposition during aging (because their daughters have no deficit in vertebral volume). Women with hip fractures have reduced vBMD because of age-related bone loss (because their daughters have no deficit in vBMD) but the increased femoral neck volume is growth related (because their daughters' femoral neck size is increased by one-half as much). The pathogenesis of bone fragility at the axial and appendicular skeleton is heterogeneous and has its origins in growth and aging.

Adult↗
PubMed1986

Incidence of hip involvement and need for total hip replacement in rheumatoid arthritis. An eight-year follow-up study.

In an 8-year follow-up of a prospective study of recent arthritis, 103 patients were found to have erosive and 97% seropositive rheumatoid arthritis. A 20% incidence of hip joint involvement was observed among them. Moderate radiological changes could be seen in 10%, severe destruction (Larsen 4 or 5) in 3%, and acetabular protrusion in 1% of the patients. It was estimated that the minimum annual need of total hip replacement in rheumatoid arthritis in Finland would be 470. This is about 100 per million in the overall population. At the end of the follow-up the Larsen X-ray index was highly significantly (p less than 0.001), ESR significantly (p less than 0.005), and CRP clearly (p less than 0.03) higher in the 13 patients with radiologically confirmed hip changes than in the 90 without them. Thus their hip destruction is attributable to a more severe disease condition and not to the glucocorticoids administered. Furthermore, HLA-B27 was positive in 69% of the above-mentioned 13 patients compared with 27% of the rest, and this difference (p less than 0.005) may also explain the poor prognosis for true rheumatoid arthritis patients.

Adolescent↗
PubMed1980

Total hip replacement in congenital dislocation of the hip.

Twenty cases of congenital dislocation of the hip were treated with total hip replacement. The hips were completely dislocated with the femoral head supported by a nearthrosis proximal to the original acetabulum. The concept was to reconstruct the hip with an acetabular cup at the site of the original acetabulum even if a portion of the proximal end of the femur had to be sacrificed in the process. The Harris prosthesis appears, in most instances, to be the most suitable type of prosthesis but it was concluded that the surgeon needs a selection or prostheses for this procedure. Nine-tenths of the patients were improved by the procedure and the complications could mostly be successfully dealt with. This type of surgery is justified in cases with special indications.

Adult↗
PubMed2001

Three-dimensional computerized selection of hip prostheses in patients with congenital dislocated hips.

This study assessed the effectiveness of the combined use of computed tomography (CT) and computer-aided design (CAD) in the preoperative evaluation and implant selection in 20 patients (20 hips) with congenital dislocation of the hip who were scheduled to undergo total hip arthroplasty. Computerized selection of the femoral implant with optimum fit and fill was made after a three-dimensional reconstruction of the femoral canal using CT data and CAD. Implantation of all sizes of 5 noncemented and 2 cemented femoral implants was simulated using CATIA software (IBM, Kingstone, NY). When patients underwent surgery, 18 of 20 preselected prostheses agreed by type and size with the prostheses implanted. The remaining 2 preselected implants agreed by type only. In patients with dislocated and dysplastic hips, combined use of CT and CAD allows effective preoperative planning by providing the surgeon with vital information about the proximal femoral canal geometry and the possible femoral implant with optimum fit and fill to be used.

Aged↗
PubMedDate not supplied

[10 years experience with denervation of the hip joint capsule for treatment of canine hip joint dysplasia and arthrosis].

Denervation of the canine hip joint capsule is described as a surgical therapy method in the treatment of canine hip joint dysplasia and arthrosis. The goal of this operation is a removal of the pain immediately and a reactivation of the dynamic active component of the hip joint in moving the body forward. Simple removal of the periosteum of the craniolateral acetabulum edge destroys the rami articulares of the cranial glutaeal nerve and the rami articulares dorsalis of the sciatic nerve. Within 10 years now we performed the denervation of the canine hip joint capsule. Evaluation of the post operative clinical course in 269 cases revealed an impressive improvement of lameness due to pain relief in almost 92% of the cases.

Animals↗
PubMed1992

Conversion of the arthrodesed hip to a total hip arthroplasty. Indications and limitations.

Arthrodesis of the hip is thought to achieve satisfactory clinical and functional results in the adult despite the loss of articular mobility involved (Santori et al., 1986; Russel, 1987; Weber, 1987). Over the long term, however, most patients develop secondary degenerative arthritis in the spine, contralateral hip, and knees due to overloading. The deteriorating condition of these joints eventually causes the onset of pain, which often requires further intervention. Surgery on these joints may yield satisfactory short-term results, but these will not last if the arthrodesed hip is not converted to total hip arthroplasty either prior to or at the same time as such operations.

Adult↗
PubMed1992

Three-dimensional evaluation of acetabular coverage of the femoral head in normal hip joints and hip joints with acetabular dysplasia.

Compared with the assessment by data processing-coupled CT scanning, three dimensional evaluations of the acetabular coverage of the femoral head from a plain X-ray picture of the hip joint is found to be a simpler and easier procedure. In addition, the calculated values agree well with those obtained by CT in reconstruction. Consequently, this method is of great value in evaluating the severity of diseases of the hip joint. The acetabular coverage of the anterior portion of the hip joint is decreased in the elderly even if the hip joint is normal. Because this decrease may result in primary arthrosis deformans, it should be studied further. Rotational acetabular osteotomy (RAO) is a far better method than Salter's for the early stage of coxarthritis. The present study concludes that it is vitally important to maintain the normal ratio of the anterior and posterior coverage and the shape of the acetabular coverage in the treatment of coxarthritis.

Acetabulum↗
PubMed2004

[Hip protectors for prevention of hip fractures in the frail elderly people].

There are good indications for the use of hip protectors in the elderly people requiring long-term care with high risks for falling and even better indications when such elderly also have risks for osteoporosis. Based on criteria for enrollment in randomized controlled trials, elderly who are eligible for long-term care facilities but have not become bedridden should use hip protectors. The use of hip protectors as a preventive approach in long-term care facilities will successfully decrease the occurrence of hip fractures in such disabled elderly people.

Aged↗
PubMed2006

[The significance of ultrasonic investigation of the hip joint with dysplasia and congenital hip joint dislocation].

The paper presents results of ultrasonography of the hip joint of 56 newborns with pathology of the hip joint detected by a clinical and ultrasonic screening, and 56 children aged from 1 through 6 months with dysplasia of the hip joint and a congenital hip dislocation. The ultrasonic examination gives an exact evaluation of the development of the joint. Measures of treatment were chosen with special reference to the patient's age and severity of the pathology. The terms of treatment depended on the age of the child and severity of the disease.

Female↗
PubMed1989

[Radiological study of the development of the hip joint in children with congenital hip dislocation treated by the Frejka cushion].

The changes in the radiological state of the hip joints between the 2-nd and the 21-st year of age in persons treated for congenital dysplasia of the hip with dislocation have been determined on the basis of the analysis of 3.005 X-razy pictures of 4 or 6 radiological parameters of 916 hip joints in 708 children and the total point evaluation. On comparing the rate of excellent, good and poor results in individual years of life, it has been concluded that marked and quick rebuilding occurs between the 2-nd and the 7-th year of age, and on the other hand, after 10 years of age the radiological state of the hip joint stabilizes.

Adolescent↗
PubMed1986

Comparison of function two years after revision of failed total hip arthroplasty and primary hip arthroplasty.

Because of the known high complication rate, it is important for both the patient and physician to know as much as possible about the outcome of revision operations for loosened total hip arthroplasties. This study evaluates the changes in subjective ratings and objective kinesiologic measurements from before revision operations through two years after revision operations. The object is to compare these measurements with the measurements of a group of patients with primary replacements. Both groups of patients showed significant improvement in most parameters from before to after surgery. These parameters included walking performance, hip muscle strength, range of motion, forces applied to canes, and the amount of weight borne on the operated limb during quiet standing. Compared to the control group with primary replacements, the group with revision used more assistive devices, had less pain relief, walked slower, had less hip motion, and had more lateral lurch. While results after revision surgery were not as gratifying as those after primary hip replacement, patients requiring revision can still anticipate substantial improvement.

Adult↗